Healthcare Provider Details

I. General information

NPI: 1164410205
Provider Name (Legal Business Name): DANIEL W. LOVELL R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 SAINT JOE RD
FORT WAYNE IN
46835-3275
US

IV. Provider business mailing address

6812 COVINGTON CREEK TRL
FORT WAYNE IN
46804-2872
US

V. Phone/Fax

Practice location:
  • Phone: 260-969-1794
  • Fax: 260-969-3879
Mailing address:
  • Phone: 260-434-1280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26020296
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberC-4968
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: