MEDICARE: DR. DANIELLE DANTUMA PHARMD

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	PS56667	FL

General Provider Information

NPI Number	:	1730604521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIELLE DANTUMA PHARMD

Provider Business Mailing Address
First Line	:	5 CITRUS DR
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-1207
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	710 150TH AVE
Second Line	:
City	:	MADEIRA BEACH
State	:	FL
Zip	:	33708-2814
Country	:	US
Telephone Number	:	727-239-6728
Fax Number	:

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

Provider Enumeration Date	:	08/14/2017
Last Update Date	:	08/14/2017

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