Healthcare Provider Details

I. General information

NPI: 1609383983
Provider Name (Legal Business Name): DANIEL MIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2018
Last Update Date: 01/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 OXFORD AVE
PHILADELPHIA PA
19111-5400
US

IV. Provider business mailing address

102 FLINTLOCK CIR
LANSDALE PA
19446-6312
US

V. Phone/Fax

Practice location:
  • Phone: 215-745-2557
  • Fax:
Mailing address:
  • Phone: 215-939-8845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP452122
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: