Provider Demographics
NPI:1316534795
Name:VACCA, DAN (RPH)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:
Last Name:VACCA
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 1:721 NORTHLAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-5281
Mailing Address - Country:US
Mailing Address - Phone:561-842-2444
Mailing Address - Fax:
Practice Address - Street 1:721 NORTHLAKE BLVD
Practice Address - Street 2:
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-5281
Practice Address - Country:US
Practice Address - Phone:561-842-2444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41031183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist