Provider Demographics
NPI:1366841991
Name:REX, DANIEL (PHARM D)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:REX
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:PO BOX 605
Mailing Address - Street 2:110 E. BUTLER STREET
Mailing Address - City:FORT RECOVERY
Mailing Address - State:OH
Mailing Address - Zip Code:45846-0605
Mailing Address - Country:US
Mailing Address - Phone:419-375-2323
Mailing Address - Fax:419-375-4488
Practice Address - Street 1:102 NORTH WAYNE STREET
Practice Address - Street 2:
Practice Address - City:FORT RECOVERY
Practice Address - State:OH
Practice Address - Zip Code:45846-0605
Practice Address - Country:US
Practice Address - Phone:419-375-2323
Practice Address - Fax:419-375-4488
Is Sole Proprietor?:No
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03233740-2183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0439243Medicaid
OH0439243Medicaid