Provider Demographics
NPI:1770614737
Name:BREITENFELDT, DANIEL E (PHARMD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:E
Last Name:BREITENFELDT
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 1:17403 E TEJON DR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-2608
Mailing Address - Country:US
Mailing Address - Phone:480-268-6467
Mailing Address - Fax:
Practice Address - Street 1:16545 E PALISADES BLVD
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-3707
Practice Address - Country:US
Practice Address - Phone:480-836-8337
Practice Address - Fax:480-836-8354
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18653183500000X
NE11052183500000X
AZS017826183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist