MEDICARE: DANIEL BABCOCK CPHT

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	183700000X	Pharmacy Technician	5303019615	MI

General Provider Information

NPI Number	:	1265052054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL BABCOCK CPHT

Provider Business Mailing Address
First Line	:	304 MYRTLE ST UNIT 411
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91203-3580
Country	:	US
Telephone Number	:	248-385-6442
Fax Number	:

Provider Business Practice Location Address
First Line	:	304 MYRTLE ST UNIT 411
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91203-3580
Country	:	US
Telephone Number	:	248-385-6442
Fax Number	:

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

Provider Enumeration Date	:	04/21/2020
Last Update Date	:	04/21/2020

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