Provider Demographics
NPI:1720370257
Name:REARDON, DANIEL GILBERT (PHARMD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:GILBERT
Last Name:REARDON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 MARION RD
Mailing Address - Street 2:
Mailing Address - City:WAREHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02571-1423
Mailing Address - Country:US
Mailing Address - Phone:508-295-5772
Mailing Address - Fax:
Practice Address - Street 1:121 MARION RD
Practice Address - Street 2:
Practice Address - City:WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02571-1423
Practice Address - Country:US
Practice Address - Phone:508-295-5772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH233391183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist