Provider Demographics
NPI:1710419718
Name:FOX, DANIEL (PHARM D)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:FOX
Suffix:
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 1:597 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-3932
Mailing Address - Country:US
Mailing Address - Phone:860-582-4080
Mailing Address - Fax:844-411-6440
Practice Address - Street 1:597 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-3932
Practice Address - Country:US
Practice Address - Phone:860-582-4080
Practice Address - Fax:844-411-6440
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12284183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist