Healthcare Provider Details

I. General information

NPI: 1164690053
Provider Name (Legal Business Name): DANIEL WILLIAM PITCHFORD R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE ST RAVDIN 1
PHILADELPHIA PA
19104-4206
US

IV. Provider business mailing address

412 SPRUCE CIR
EXTON PA
19341-2018
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-2920
  • Fax: 215-349-8340
Mailing address:
  • Phone: 610-594-7019
  • Fax: 610-594-7019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP032471L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11302
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: