Provider Demographics
NPI:1013248707
Name:OPSAHL, DANA MATTHEW (PHARMD)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:MATTHEW
Last Name:OPSAHL
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 1:8301 W. CAMELBACK RD.
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-1257
Mailing Address - Country:US
Mailing Address - Phone:623-849-4278
Mailing Address - Fax:623-849-5437
Practice Address - Street 1:8301 W CAMELBACK RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-1257
Practice Address - Country:US
Practice Address - Phone:623-849-4278
Practice Address - Fax:623-849-5437
Is Sole Proprietor?:No
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS017179183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist