Provider Demographics
NPI:1245721844
Name:DEMOCK, DANIEL (PHARM D)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:DEMOCK
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 DONIPHAN DR
Mailing Address - Street 2:STE 201
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79932-1441
Mailing Address - Country:US
Mailing Address - Phone:915-772-5331
Mailing Address - Fax:
Practice Address - Street 1:4900 ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2802
Practice Address - Country:US
Practice Address - Phone:915-772-5331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-20
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43685183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist