Healthcare Provider Details

I. General information

NPI: 1962863290
Provider Name (Legal Business Name): DANIEL BISHOP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2016
Last Update Date: 03/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 E 23RD AVE
HUTCHINSON KS
67502-1105
US

IV. Provider business mailing address

1701 E 23RD AVE
HUTCHINSON KS
67502-1105
US

V. Phone/Fax

Practice location:
  • Phone: 620-665-2101
  • Fax:
Mailing address:
  • Phone: 620-665-2101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-16917
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2015026760
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: