MEDICARE: SANDRA L DAILY R.PH.

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	5302026390	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730672254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA L DAILY R.PH.

Provider Business Mailing Address
First Line	:	25014 LITTLE MACK AVE
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48080-1118
Country	:	US
Telephone Number	:	586-359-2617
Fax Number	:	586-359-6523

Provider Business Practice Location Address
First Line	:	25014 LITTLE MACK AVE
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48080-1118
Country	:	US
Telephone Number	:	586-359-6517
Fax Number	:	586-359-6523

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

Provider Enumeration Date	:	06/09/2018
Last Update Date	:	06/09/2018

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