Provider Demographics
NPI:1316204365
Name:FOUGNER, DANIEL W (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:W
Last Name:FOUGNER
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 HIGHWAY 10 W
Mailing Address - Street 2:
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56501-2214
Mailing Address - Country:US
Mailing Address - Phone:218-847-9755
Mailing Address - Fax:218-847-9756
Practice Address - Street 1:1305 HIGHWAY 10 W
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-2214
Practice Address - Country:US
Practice Address - Phone:218-847-9755
Practice Address - Fax:218-847-9756
Is Sole Proprietor?:No
Enumeration Date:2012-04-16
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117554183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist