Provider Demographics
NPI:1821126244
Name:MLYNAREK, DANIEL A (RPH)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:A
Last Name:MLYNAREK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41627 VANCOUVER DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-4161
Mailing Address - Country:US
Mailing Address - Phone:586-731-3742
Mailing Address - Fax:
Practice Address - Street 1:29240 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-2309
Practice Address - Country:US
Practice Address - Phone:586-582-0967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302022707183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist