Provider Demographics
NPI:1619040060
Name:NELSON, DANA BRUCE (RPH)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:BRUCE
Last Name:NELSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 VISTA DE LA MONTANA
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-4843
Mailing Address - Country:US
Mailing Address - Phone:805-543-3784
Mailing Address - Fax:
Practice Address - Street 1:HEALTHPLUS PHARMACY INC
Practice Address - Street 2:948 A FOOTHILL BLVD
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-2701
Practice Address - Country:US
Practice Address - Phone:805-543-5966
Practice Address - Fax:805-543-3160
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH27177183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist