Provider Demographics
NPI:1356653232
Name:MAULL, DANIEL (RPH)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:MAULL
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 1:1492 CHEWS LANDING RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL SPRINGS
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-2797
Mailing Address - Country:US
Mailing Address - Phone:856-401-1900
Mailing Address - Fax:
Practice Address - Street 1:1492 CHEWS LANDING RD
Practice Address - Street 2:
Practice Address - City:LAUREL SPRINGS
Practice Address - State:NJ
Practice Address - Zip Code:08021-2797
Practice Address - Country:US
Practice Address - Phone:856-401-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02400800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7038500Medicaid