Provider Demographics
NPI:1023385143
Name:DUGGAN, DAN (RPH)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:
Last Name:DUGGAN
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 1:1918 W FABYAN PKWY
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-1215
Mailing Address - Country:US
Mailing Address - Phone:630-482-2485
Mailing Address - Fax:
Practice Address - Street 1:1918 W FABYAN PKWY
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-1215
Practice Address - Country:US
Practice Address - Phone:630-482-2485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051033300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0510033300OtherILLINOIS