Provider Demographics
NPI:1295932929
Name:BOARDMAN, DANIEL ROBERT (PHARMD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:ROBERT
Last Name:BOARDMAN
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:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:PEACH SPRINGS
Mailing Address - State:AZ
Mailing Address - Zip Code:86434-0190
Mailing Address - Country:US
Mailing Address - Phone:928-769-2992
Mailing Address - Fax:928-769-1336
Practice Address - Street 1:943 HUALAPAI WAY
Practice Address - Street 2:
Practice Address - City:PEACH SPRINGS
Practice Address - State:AZ
Practice Address - Zip Code:86434-0190
Practice Address - Country:US
Practice Address - Phone:928-769-2992
Practice Address - Fax:928-769-1336
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ016350183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist