Provider Demographics
NPI:1710587399
Name:DAGNE, DANIEL W
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:W
Last Name:DAGNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24718 MALCA MANOR DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-2563
Mailing Address - Country:US
Mailing Address - Phone:832-526-7403
Mailing Address - Fax:
Practice Address - Street 1:1506 N TEXANA ST
Practice Address - Street 2:
Practice Address - City:HALLETTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77964-2036
Practice Address - Country:US
Practice Address - Phone:361-798-4379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-31
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51058183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist