Provider Demographics
NPI:1518145770
Name:STERN, DANIEL HARRIS (RPH)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:HARRIS
Last Name:STERN
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 1:130 MIDLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PORT CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10573-4916
Mailing Address - Country:US
Mailing Address - Phone:914-937-0996
Mailing Address - Fax:
Practice Address - Street 1:130 MIDLAND AVE
Practice Address - Street 2:
Practice Address - City:PORT CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10573-4916
Practice Address - Country:US
Practice Address - Phone:914-937-0996
Practice Address - Fax:914-937-5015
Is Sole Proprietor?:No
Enumeration Date:2008-02-09
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032777-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02865429Medicaid
NY032777-1OtherLICENSE