MEDICARE: DAWN PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1053378760	OTHER	CA	CURRENT NPI

General Provider Information

NPI Number	:	1063396026
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAWN PHARMACY

Provider Business Mailing Address
First Line	:	4776 EL CAJON BLVD STE 105
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-4521
Country	:	US
Telephone Number	:	619-287-1206
Fax Number	:	619-287-8975

Provider Business Practice Location Address
First Line	:	4776 EL CAJON BLVD STE 105
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-4521
Country	:	US
Telephone Number	:	619-287-1206
Fax Number	:	619-287-8975

Authorized Official
Title or Position	:	OWNER
Name	:	TAMMY NGUYEN
Credential	:	PHARMD
Telephone Number	:	619-788-3167

Provider Enumeration Date	:	08/04/2025
Last Update Date	:	08/04/2025

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Directions to “DAWN PHARMACY ” Practice Location

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