Basic Information
| Provider Information | |||||||||
| NPI: | 1619590346 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DANIEL | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 909 N IOWA AVE | ||||||||
| Address2: | |||||||||
| City: | DELL RAPIDS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 570221231 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 214 N PRAIRIE ST | ||||||||
| Address2: | |||||||||
| City: | FLANDREAU | ||||||||
| State: | SD | ||||||||
| PostalCode: | 570281243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6059972433 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2020 | ||||||||
| LastUpdateDate: | 05/28/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 6161 | SD | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.