MEDICARE: DANIEL PAGE

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	183500000X	Pharmacist	42877	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RPH 42877	OTHER	CA	CALIFORNIA BOARD OF PHARMACY

General Provider Information

NPI Number	:	1073989422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL PAGE

Provider Business Mailing Address
First Line	:	4419 47TH ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-4516
Country	:	US
Telephone Number	:	619-282-1338
Fax Number	:	619-282-1127

Provider Business Practice Location Address
First Line	:	4419 47TH ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-4516
Country	:	US
Telephone Number	:	619-282-1338
Fax Number	:	619-282-1127

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2015
Last Update Date	:	08/19/2015

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Directions to “ DANIEL PAGE ” Practice Location

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