Provider Demographics
NPI:1639703937
Name:HAYWOOD, DANIEL
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:HAYWOOD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DANIEL
Other - Middle Name:
Other - Last Name:HAYWOOD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2126 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-3484
Mailing Address - Country:US
Mailing Address - Phone:630-334-3667
Mailing Address - Fax:
Practice Address - Street 1:1950 W GALENA BLVD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-4306
Practice Address - Country:US
Practice Address - Phone:630-892-9075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051301686183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist