Basic Information
| Provider Information | |||||||||
| NPI: | 1003822958 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAHL | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | JEROME | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARM.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 346 GLENCREST DR | ||||||||
| Address2: | |||||||||
| City: | SOLANA BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920751407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8586421174 | ||||||||
| FaxNumber: | 8585527485 | ||||||||
| Practice Location | |||||||||
| Address1: | VA MEDICAL CTR | ||||||||
| Address2: | 3350 LA JOLLA VILLAGE DR | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921610001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8586421174 | ||||||||
| FaxNumber: | 8585527485 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 41420 | CA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.