MEDICARE: DAVID KAVISH

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	RPH-0019359	OR

General Provider Information

NPI Number	:	1841023629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID KAVISH

Provider Business Mailing Address
First Line	:	11227 CHARLES CT
Second Line	:
City	:	DAWSON
State	:	IL
Zip	:	62520-3020
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1380 LEAD HILL BLVD STE 260
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95661-2998
Country	:	US
Telephone Number	:	916-237-8833
Fax Number	:

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

Provider Enumeration Date	:	08/26/2024
Last Update Date	:	08/26/2024

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Directions to “ DAVID KAVISH ” Practice Location

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