Provider Demographics
NPI:1003100751
Name:NGHIEM, DANIEL M (RPH)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:M
Last Name:NGHIEM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 DAVENTRY LN
Mailing Address - Street 2:
Mailing Address - City:WOLCOTT
Mailing Address - State:CT
Mailing Address - Zip Code:06716-2347
Mailing Address - Country:US
Mailing Address - Phone:203-879-6746
Mailing Address - Fax:
Practice Address - Street 1:620 MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:CT
Practice Address - Zip Code:06795-2614
Practice Address - Country:US
Practice Address - Phone:860-274-7559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-29
Last Update Date:2011-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7647183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist