MEDICARE: DAYNE VIVAR

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	66189	CA

General Provider Information

NPI Number	:	1184994055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAYNE VIVAR

Provider Business Mailing Address
First Line	:	2005 TOWN CENTER PLZ
Second Line	:	T2268
City	:	WEST SACRAMENTO
State	:	CA
Zip	:	95691-4957
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2005 TOWN CENTER PLZ
Second Line	:	T2268
City	:	WEST SACRAMENTO
State	:	CA
Zip	:	95691-4957
Country	:	US
Telephone Number	:	916-384-0978
Fax Number	:

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

Provider Enumeration Date	:	01/09/2012
Last Update Date	:	01/09/2012

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