Provider Demographics
NPI:1154605947
Name:ANDERSON, DANA BRIAN (PHARM D)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:BRIAN
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2135 E WARWICK AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3914
Mailing Address - Country:US
Mailing Address - Phone:559-321-8509
Mailing Address - Fax:559-353-6308
Practice Address - Street 1:41169 GOODWIN WAY
Practice Address - Street 2:WALGREENS-12761
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93636-8766
Practice Address - Country:US
Practice Address - Phone:559-353-6300
Practice Address - Fax:559-353-6308
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH29198183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist