Provider Demographics
NPI:1871866004
Name:DEHAAN, DANIEL H (PHARMD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:H
Last Name:DEHAAN
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 1:603 MARKETPLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-2231
Mailing Address - Country:US
Mailing Address - Phone:269-491-3188
Mailing Address - Fax:
Practice Address - Street 1:319 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:PAW PAW
Practice Address - State:MI
Practice Address - Zip Code:49079-1426
Practice Address - Country:US
Practice Address - Phone:269-657-4440
Practice Address - Fax:269-655-2952
Is Sole Proprietor?:No
Enumeration Date:2012-02-19
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302038638183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist