Provider Demographics
NPI:1376698969
Name:DANIEL DRUG, INC
Entity Type:Organization
Organization Name:DANIEL DRUG, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FUCHSHUBER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:817-332-6386
Mailing Address - Street 1:3409 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-2718
Mailing Address - Country:US
Mailing Address - Phone:817-332-6386
Mailing Address - Fax:817-332-6645
Practice Address - Street 1:3409 W 7TH ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-2718
Practice Address - Country:US
Practice Address - Phone:817-332-6386
Practice Address - Fax:817-332-6645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16252333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4520094OtherNCPDP
TX144422Medicaid
0941580001Medicare ID - Type Unspecified