Provider Demographics
NPI:1285849794
Name:BADALOV, DANIEL (RPH)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:BADALOV
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 1:99-31 64 AVE
Mailing Address - Street 2:APT F8
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374
Mailing Address - Country:US
Mailing Address - Phone:718-830-3759
Mailing Address - Fax:
Practice Address - Street 1:9931 64TH AVE
Practice Address - Street 2:APT F8
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2652
Practice Address - Country:US
Practice Address - Phone:718-830-3759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047434183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist