Healthcare Provider Details

I. General information

NPI: 1184640443
Provider Name (Legal Business Name): TERRY ALLEN DAANE R.PH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 11/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S 99TH AVE
TOLLESON AZ
85353-9700
US

IV. Provider business mailing address

500 S 99TH AVE
TOLLESON AZ
85353-9700
US

V. Phone/Fax

Practice location:
  • Phone: 602-818-5260
  • Fax:
Mailing address:
  • Phone: 602-818-5260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7345
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: