Healthcare Provider Details

I. General information

NPI: 1184694572
Provider Name (Legal Business Name): DANIEL HASENFANG RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COMDT (CG-1122) 2100 2ND STREET SW ROOM 5314
WASHINGTON DC
20593
US

IV. Provider business mailing address

COMDT (CG-1122) 2100 2ND STREET SW ROOM 5314
WASHINGTON DC
20593
US

V. Phone/Fax

Practice location:
  • Phone: 609-898-6863
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302028988
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: