Provider Demographics
NPI:1164695961
Name:WIERCINSKI, DANIEL F (RPH)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:F
Last Name:WIERCINSKI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 WELLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-2419
Mailing Address - Country:US
Mailing Address - Phone:516-385-5376
Mailing Address - Fax:516-294-0366
Practice Address - Street 1:1580 ROUTE 112
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-3632
Practice Address - Country:US
Practice Address - Phone:631-207-9234
Practice Address - Fax:631-207-9502
Is Sole Proprietor?:No
Enumeration Date:2008-04-11
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040076183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist