MEDICARE: DANCA LENNA INC

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	00506	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	3805097	OTHER	OTHER ID NUMBER
3	3805097	OTHER	OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1609919760
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANCA LENNA INC

Provider Business Mailing Address
First Line	:	1023 MAIN ST
Second Line	:
City	:	SWEET HOME
State	:	OR
Zip	:	97386-1515
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1023 MAIN ST
Second Line	:
City	:	SWEET HOME
State	:	OR
Zip	:	97386-1515
Country	:	US
Telephone Number	:	541-367-4231
Fax Number	:	541-367-2825

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID REDDEN
Credential	:	RPH
Telephone Number	:	541-367-4668

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	09/12/2007

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Directions to “DANCA LENNA INC ” Practice Location

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