MEDICARE: Y NHU DANG

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	RP041512L	PA

General Provider Information

NPI Number	:	1720392400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	Y NHU DANG

Provider Business Mailing Address
First Line	:	234 BUCKINGHAM PL
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-2921
Country	:	US
Telephone Number	:	215-222-4534
Fax Number	:

Provider Business Practice Location Address
First Line	:	2201 W ALLEGHENY AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19132-1420
Country	:	US
Telephone Number	:	215-223-8979
Fax Number	:

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

Provider Enumeration Date	:	08/04/2010
Last Update Date	:	08/04/2010

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