Provider Demographics
NPI:1023126224
Name:GERSON, DANIEL BREEZE (CGP)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:BREEZE
Last Name:GERSON
Suffix:
Gender:M
Credentials:CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3461 CIVIC CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4302
Mailing Address - Country:US
Mailing Address - Phone:215-823-4509
Mailing Address - Fax:215-823-4464
Practice Address - Street 1:3461 CIVIC CENTER BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4302
Practice Address - Country:US
Practice Address - Phone:215-823-4509
Practice Address - Fax:215-823-4464
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP037408L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist