MEDICARE: MR. GERALD DANIEL TO R.PH.

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	PH00042474	WA
2	183500000X	Pharmacist	RPH-0010308	OR

General Provider Information

NPI Number	:	1528241544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GERALD DANIEL TO R.PH.

Provider Business Mailing Address
First Line	:	15504 105TH AVE NE
Second Line	:
City	:	BOTHELL
State	:	WA
Zip	:	98011-4023
Country	:	US
Telephone Number	:	425-290-2435
Fax Number	:

Provider Business Practice Location Address
First Line	:	12501 E MARGINAL WAY S
Second Line	:
City	:	TUKWILA
State	:	WA
Zip	:	98168-2560
Country	:	US
Telephone Number	:	425-290-2435
Fax Number	:

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

Provider Enumeration Date	:	12/12/2007
Last Update Date	:	12/12/2007

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