Provider Demographics
NPI:1790127181
Name:PELLETIER, DANIEL ADAM (PHARMD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ADAM
Last Name:PELLETIER
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 1:2255 W GERMANN RD
Mailing Address - Street 2:#1150
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-7101
Mailing Address - Country:US
Mailing Address - Phone:563-940-0792
Mailing Address - Fax:
Practice Address - Street 1:55 E RAY RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-3337
Practice Address - Country:US
Practice Address - Phone:480-782-7773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS019941183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist