Provider Demographics
NPI:1609881234
Name:DANIEL J. HORN
Entity Type:Organization
Organization Name:DANIEL J. HORN
Other - Org Name:DAN HORN PHARMACY AND HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:HORN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:716-376-6337
Mailing Address - Street 1:111 E GREEN ST
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-3641
Mailing Address - Country:US
Mailing Address - Phone:716-376-6337
Mailing Address - Fax:716-372-2634
Practice Address - Street 1:111 E. GREEN ST
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-3641
Practice Address - Country:US
Practice Address - Phone:716-376-6337
Practice Address - Fax:716-372-2634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332800000X, 332B00000X, 3336C0004X
NY0238223336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2057150OtherPK
NY1904916Medicaid
NY01904916Medicaid