Provider Demographics
NPI:1942584727
Name:DANIEL'S PHARMACY INC
Entity Type:Organization
Organization Name:DANIEL'S PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAAFAT
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:GERGES
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:909-263-7912
Mailing Address - Street 1:126 AVOCADO AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92571-2605
Mailing Address - Country:US
Mailing Address - Phone:951-943-6300
Mailing Address - Fax:
Practice Address - Street 1:126 AVOCADO AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-2605
Practice Address - Country:US
Practice Address - Phone:951-943-6300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA507003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy