Provider Demographics
NPI:1831725316
Name:DANIELSON PHARMACY LLC
Entity type:Organization
Organization Name:DANIELSON PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SANDHYA
Authorized Official - Middle Name:RANI
Authorized Official - Last Name:KANTAMANENI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-414-1977
Mailing Address - Street 1:77 WESTCOTT RD
Mailing Address - Street 2:
Mailing Address - City:DANIELSON
Mailing Address - State:CT
Mailing Address - Zip Code:06239-2929
Mailing Address - Country:US
Mailing Address - Phone:860-774-0050
Mailing Address - Fax:
Practice Address - Street 1:77 WESTCOTT RD
Practice Address - Street 2:
Practice Address - City:DANIELSON
Practice Address - State:CT
Practice Address - Zip Code:06239-2929
Practice Address - Country:US
Practice Address - Phone:860-774-0050
Practice Address - Fax:860-774-0060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-17
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy