Provider Demographics
NPI:1609271246
Name:CRIDER, DANIEL (RPH)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:CRIDER
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 1:3721 W TRUMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CTY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-0536
Mailing Address - Country:US
Mailing Address - Phone:573-634-2628
Mailing Address - Fax:573-635-1768
Practice Address - Street 1:3721 W TRUMAN BLVD
Practice Address - Street 2:
Practice Address - City:JEFFERSON CTY
Practice Address - State:MO
Practice Address - Zip Code:65109-0536
Practice Address - Country:US
Practice Address - Phone:573-634-2628
Practice Address - Fax:573-635-1768
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO041723183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist