Provider Demographics
NPI:1679558381
Name:DANIELS PHARMACY INC
Entity type:Organization
Organization Name:DANIELS PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FIORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-774-3214
Mailing Address - Street 1:42 REYNOLDS ST
Mailing Address - Street 2:
Mailing Address - City:DANIELSON
Mailing Address - State:CT
Mailing Address - Zip Code:06239-2917
Mailing Address - Country:US
Mailing Address - Phone:860-774-3214
Mailing Address - Fax:860-774-2426
Practice Address - Street 1:42 REYNOLDS ST
Practice Address - Street 2:
Practice Address - City:DANIELSON
Practice Address - State:CT
Practice Address - Zip Code:06239-2917
Practice Address - Country:US
Practice Address - Phone:860-774-3214
Practice Address - Fax:860-774-2426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-14
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
CT16113336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004169927Medicaid
0713188OtherNCPDP PROVIDER IDENTIFICATION NUMBER
0713188OtherNCPDP PROVIDER IDENTIFICATION NUMBER