Provider Demographics
NPI:1700882008
Name:DANAURA ENTERPRISES PC
Entity Type:Organization
Organization Name:DANAURA ENTERPRISES PC
Other - Org Name:NUTRI-FARMACY, MED-PHARM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D, MBA, RPH
Authorized Official - Phone:412-486-4588
Mailing Address - Street 1:PO BOX 238
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:15091-0238
Mailing Address - Country:US
Mailing Address - Phone:412-486-4588
Mailing Address - Fax:412-486-0246
Practice Address - Street 1:2506 WILDWOOD ROAD
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:PA
Practice Address - Zip Code:15091
Practice Address - Country:US
Practice Address - Phone:412-486-4588
Practice Address - Fax:412-486-0246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP415155L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3971428OtherNABP
PA0397142Medicaid
PA0130840001Medicare ID - Type Unspecified