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NPI Code Detail

MEDICARE: DAVID DAUGHERTY

MEDICARE:   DAVID  DAUGHERTY
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
1183500000XPharmacistPS44210FL

General Provider Information

NPI Number : 1457621021
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID DAUGHERTY
Provider Business Mailing Address
First Line : 2149 PINEVIEW CIR
Second Line :
City : PENSACOLA
State : FL
Zip : 32526-8877
Country : US
Telephone Number : 314-517-6069
Fax Number :
Provider Business Practice Location Address
First Line : 6314 N 9TH AVE
Second Line :
City : PENSACOLA
State : FL
Zip : 32504-7320
Country : US
Telephone Number : 850-476-9669
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2012
Last Update Date : 01/12/2012

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Directions to “ DAVID DAUGHERTY ” Practice Location

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