Provider Demographics
NPI:1740300110
Name:CHURCHILL, DANIEL MOORE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:MOORE
Last Name:CHURCHILL
Suffix:
Gender:
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 W TURNPIKE AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-1300
Mailing Address - Country:US
Mailing Address - Phone:701-224-0339
Mailing Address - Fax:701-224-0534
Practice Address - Street 1:1190 W TURNPIKE AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-1300
Practice Address - Country:US
Practice Address - Phone:701-224-0339
Practice Address - Fax:701-224-0534
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4907183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDCH30393OtherBCBSND PROVIDER ID