Provider Demographics
NPI:1932327079
Name:RAFFERTY, DAN A (R PH)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:A
Last Name:RAFFERTY
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 TULIP POPLAR DR
Mailing Address - Street 2:
Mailing Address - City:LA VERGNE
Mailing Address - State:TN
Mailing Address - Zip Code:37086-2022
Mailing Address - Country:US
Mailing Address - Phone:615-995-2008
Mailing Address - Fax:
Practice Address - Street 1:5215 LINBAR DR
Practice Address - Street 2:SUITE 210
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-1031
Practice Address - Country:US
Practice Address - Phone:615-438-8235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9244183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist