Healthcare Provider Details

I. General information

NPI: 1184392615
Provider Name (Legal Business Name): DANIEL J HORN DBA DAN HORN PHARMACY AND HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 11/05/2021
Certification Date: 11/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E GREEN ST
OLEAN NY
14760-3641
US

IV. Provider business mailing address

111 E GREEN ST
OLEAN NY
14760-3641
US

V. Phone/Fax

Practice location:
  • Phone: 716-376-6337
  • Fax: 716-372-2634
Mailing address:
  • Phone: 716-376-6337
  • Fax: 716-372-2634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1609881234
Identifier TypeOTHER
Identifier State
Identifier IssuerNPI NUMBER
# 2
Identifier01904916
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name: DANIEL JOSEPH HORN
Title or Position: OWNER
Credential: RPH
Phone: 716-376-6337