Provider Demographics
NPI:1679800080
Name:NSOFOR, DANIEL O SR (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:O
Last Name:NSOFOR
Suffix:SR
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 LORIENT DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5569
Mailing Address - Country:US
Mailing Address - Phone:682-552-8285
Mailing Address - Fax:
Practice Address - Street 1:2410 BALLPARK WAY
Practice Address - Street 2:WALGREENS
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006-4615
Practice Address - Country:US
Practice Address - Phone:817-861-7661
Practice Address - Fax:817-861-7667
Is Sole Proprietor?:No
Enumeration Date:2009-11-05
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41220183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist