MEDICARE: DR. DWIGHT UTZMAN 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
1	183500000X	Pharmacist	55303	CA

General Provider Information

NPI Number	:	1710976931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DWIGHT UTZMAN PHARM.D.

Provider Business Mailing Address
First Line	:	521 PARNASSUS AVE
Second Line	:	C-152 BOX 0622
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94143-2206
Country	:	US
Telephone Number	:	415-353-8851
Fax Number	:	415-353-1097

Provider Business Practice Location Address
First Line	:	521 PARNASSUS AVE
Second Line	:	C-152 BOX 0622
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94143-2206
Country	:	US
Telephone Number	:	415-353-8851
Fax Number	:	415-353-1097

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

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	07/08/2007

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