Basic Information
Provider Information
NPI: 1356433981
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DUNN
FirstName: MICHAEL
MiddleName: BRENDAN
NamePrefix: DR.
NameSuffix:  
Credential: PHARM.D., BCPS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8823 SPECTRUM CENTER BLVD
Address2: APT #2312
City: SAN DIEGO
State: CA
PostalCode: 921231456
CountryCode: US
TelephoneNumber: 8583956042
FaxNumber:  
Practice Location
Address1: VA SAN DIEGO HEALTHCARE SYSTEM PHARMACY # 119
Address2: 3350 LA JOLLA VILLAGE DRIVE
City: SAN DIEGO
State: CA
PostalCode: 921610001
CountryCode: US
TelephoneNumber: 8585528585
FaxNumber: 8585527582
Other Information
ProviderEnumerationDate: 09/29/2006
LastUpdateDate: 09/20/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000X58480CAY Pharmacy Service ProvidersPharmacist 

No ID Information.


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