Provider Demographics
NPI:1841615382
Name:BACK, JOSEPH DANIEL JR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:DANIEL
Last Name:BACK
Suffix:JR
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 1:1000 SPRUCE GLN
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:OH
Mailing Address - Zip Code:45152-7942
Mailing Address - Country:US
Mailing Address - Phone:513-238-3131
Mailing Address - Fax:
Practice Address - Street 1:1000 SPRUCE GLN
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:OH
Practice Address - Zip Code:45152-7942
Practice Address - Country:US
Practice Address - Phone:513-238-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03228210183500000X
KY013851183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist