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NPI Code Detail

MEDICARE: DR. DAINA CAMILLE NELSON PHARM,D

MEDICARE: DR. DAINA CAMILLE NELSON PHARM,D
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
1183500000XPharmacist051286361IL

General Provider Information

NPI Number : 1396349908
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAINA CAMILLE NELSON PHARM,D
Provider Business Mailing Address
First Line : 6150 N BROADWAY ST
Second Line :
City : CHICAGO
State : IL
Zip : 60660-2538
Country : US
Telephone Number : 773-274-9337
Fax Number : 773-274-9316
Provider Business Practice Location Address
First Line : 6150 N BROADWAY ST
Second Line :
City : CHICAGO
State : IL
Zip : 60660-2538
Country : US
Telephone Number : 773-274-9337
Fax Number : 773-274-9316
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/24/2020
Last Update Date : 11/24/2020

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