Provider Demographics
NPI:1083931802
Name:BRACKEN, DANIEL LEE (BSCPH)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:LEE
Last Name:BRACKEN
Suffix:
Gender:M
Credentials:BSCPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 IVY CT
Mailing Address - Street 2:
Mailing Address - City:DOUGLASSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19518-1133
Mailing Address - Country:US
Mailing Address - Phone:610-823-5248
Mailing Address - Fax:
Practice Address - Street 1:1140 TOWN SQUARE RD
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19465-1017
Practice Address - Country:US
Practice Address - Phone:610-323-4080
Practice Address - Fax:610-970-6316
Is Sole Proprietor?:No
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP031096L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist