Basic Information
| Provider Information | |||||||||
| NPI: | 1326021098 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEHRENS | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | RAYMOND | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARM.D., R.PH. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 794 | ||||||||
| Address2: | |||||||||
| City: | OXFORD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450560794 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374440133 | ||||||||
| FaxNumber: | 9374441442 | ||||||||
| Practice Location | |||||||||
| Address1: | 131 N POINT DR | ||||||||
| Address2: | |||||||||
| City: | MOUNT ORAB | ||||||||
| State: | OH | ||||||||
| PostalCode: | 451548366 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374440133 | ||||||||
| FaxNumber: | 9374441442 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/27/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 03-2-19310 | OH | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.