Provider Demographics
NPI:1104195023
Name:QUAN, DANIEL BRIAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:BRIAN
Last Name:QUAN
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 1:12286 BRIDGEWATER WAY
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-2775
Mailing Address - Country:US
Mailing Address - Phone:562-430-4847
Mailing Address - Fax:
Practice Address - Street 1:5913 CARSON ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90713-3104
Practice Address - Country:US
Practice Address - Phone:562-429-9120
Practice Address - Fax:562-429-8340
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45719183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist