Healthcare Provider Details

I. General information

NPI: 1407949449
Provider Name (Legal Business Name): DANIEL MARK BODNAR RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8836 STATE ROUTE 434
APALACHIN NY
13732-4102
US

IV. Provider business mailing address

904 MCFALL RD
APALACHIN NY
13732-3748
US

V. Phone/Fax

Practice location:
  • Phone: 607-625-4151
  • Fax:
Mailing address:
  • Phone: 607-625-5367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number041022-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: