Provider Demographics
NPI:1821277351
Name:BOSHART, DANIEL VANN (RPH)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:VANN
Last Name:BOSHART
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 1:1 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:NY
Mailing Address - Zip Code:13619-9503
Mailing Address - Country:US
Mailing Address - Phone:315-493-3606
Mailing Address - Fax:315-493-1748
Practice Address - Street 1:401 STATE ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:NY
Practice Address - Zip Code:13619-1413
Practice Address - Country:US
Practice Address - Phone:315-493-0150
Practice Address - Fax:315-493-3226
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034650183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist