Provider Demographics
NPI:1992015390
Name:CULLEN, DANIEL (RPH)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:CULLEN
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:PO BOX 5428
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:CO
Mailing Address - Zip Code:81631-5428
Mailing Address - Country:US
Mailing Address - Phone:303-819-4913
Mailing Address - Fax:
Practice Address - Street 1:5195 WADSWORTH BLVD
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002-4617
Practice Address - Country:US
Practice Address - Phone:970-328-7610
Practice Address - Fax:970-328-7607
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15792183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist