Provider Demographics
NPI:1053755629
Name:LUGO, DANIEL TOMAS (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:TOMAS
Last Name:LUGO
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 1:32 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:MINE HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:07803-2418
Mailing Address - Country:US
Mailing Address - Phone:201-709-2578
Mailing Address - Fax:
Practice Address - Street 1:260 US HIGHWAY 46
Practice Address - Street 2:
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-3854
Practice Address - Country:US
Practice Address - Phone:973-664-9412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-25
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03503600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist