Provider Demographics
NPI:1356305593
Name:WEARSCH, DANIEL PETER (RPH)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:PETER
Last Name:WEARSCH
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 1:11 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-1318
Mailing Address - Country:US
Mailing Address - Phone:330-286-0226
Mailing Address - Fax:330-286-0269
Practice Address - Street 1:11 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-1318
Practice Address - Country:US
Practice Address - Phone:330-286-0226
Practice Address - Fax:330-286-0269
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03315871183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0947471Medicaid