Provider Demographics
NPI:1093443061
Name:DANIELS, JARRET (PHARMD)
Entity Type:Individual
Prefix:
First Name:JARRET
Middle Name:
Last Name:DANIELS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 E SPENCER ST APT A
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-5607
Mailing Address - Country:US
Mailing Address - Phone:443-684-0789
Mailing Address - Fax:
Practice Address - Street 1:100 RANO BLVD
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-2776
Practice Address - Country:US
Practice Address - Phone:607-798-8878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-09
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28690183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist