Provider Demographics
NPI:1265052054
Name:BABCOCK, DANIEL (CPHT)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:BABCOCK
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 MYRTLE ST UNIT 411
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-3580
Mailing Address - Country:US
Mailing Address - Phone:248-385-6442
Mailing Address - Fax:
Practice Address - Street 1:304 MYRTLE ST UNIT 411
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-3580
Practice Address - Country:US
Practice Address - Phone:248-385-6442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-21
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5303019615183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician