MEDICARE: DAMIAN DARTEZ RPH

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	16283	OK

General Provider Information

NPI Number	:	1225540842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAMIAN DARTEZ RPH

Provider Business Mailing Address
First Line	:	2323 N MARTIN LUTHER KING AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73111-2405
Country	:	US
Telephone Number	:	405-424-0557
Fax Number	:	405-424-0105

Provider Business Practice Location Address
First Line	:	2323 N MARTIN LUTHER KING AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73111-2405
Country	:	US
Telephone Number	:	405-424-0557
Fax Number	:	405-424-0105

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

Provider Enumeration Date	:	11/05/2017
Last Update Date	:	11/05/2017

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