Provider Demographics
NPI:1811339021
Name:GOBANA, DANI MIDASO (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DANI
Middle Name:MIDASO
Last Name:GOBANA
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 1:18512 SW RIGERT RD
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-5681
Mailing Address - Country:US
Mailing Address - Phone:503-422-2194
Mailing Address - Fax:
Practice Address - Street 1:4346 NE CULLY BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97218-2206
Practice Address - Country:US
Practice Address - Phone:503-288-0836
Practice Address - Fax:503-288-2250
Is Sole Proprietor?:No
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0012404183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist