Provider Demographics
NPI:1134744543
Name:STEVENS, DANIEL RICHARD (PHARMD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:RICHARD
Last Name:STEVENS
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 1:131 MONROE ST APT 2N
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-6591
Mailing Address - Country:US
Mailing Address - Phone:413-454-5423
Mailing Address - Fax:
Practice Address - Street 1:131 MONROE ST APT 2N
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-6591
Practice Address - Country:US
Practice Address - Phone:413-454-5423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP446871183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist