MEDICARE: MR. DANIEL E WASSERMAN

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	PS49818	FL
2	183500000X	Pharmacist	S010404	AZ

General Provider Information

NPI Number	:	1679996839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL E WASSERMAN

Provider Business Mailing Address
First Line	:	2937 POINTEVIEW DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33611-5343
Country	:	US
Telephone Number	:	480-570-1229
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 W KENNEDY BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33606-1844
Country	:	US
Telephone Number	:	813-254-6326
Fax Number	:

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

Provider Enumeration Date	:	01/23/2014
Last Update Date	:	01/23/2014

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Directions to “ MR. DANIEL E WASSERMAN ” Practice Location

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