Provider Demographics
NPI:1114934627
Name:CALDWELL, DANA BURTON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:BURTON
Last Name:CALDWELL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6585 CLARK RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-3500
Mailing Address - Country:US
Mailing Address - Phone:530-877-3712
Mailing Address - Fax:530-877-5739
Practice Address - Street 1:6585 CLARK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-3500
Practice Address - Country:US
Practice Address - Phone:530-877-3712
Practice Address - Fax:530-877-5739
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH28166183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARPH28166OtherPHARMACIST LICENSE