Provider Demographics
NPI:1073951018
Name:FARRIS, DANIEL EDWARD (RPH)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:EDWARD
Last Name:FARRIS
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 1:5595 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33982-1588
Mailing Address - Country:US
Mailing Address - Phone:941-628-6083
Mailing Address - Fax:941-255-3724
Practice Address - Street 1:5595 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33982-1588
Practice Address - Country:US
Practice Address - Phone:941-628-6083
Practice Address - Fax:941-255-3724
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS26759183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist