Provider Demographics
NPI:1881759819
Name:BOSLEY, DANIEL ALLAN (RPH)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:ALLAN
Last Name:BOSLEY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:KEESEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12944-3618
Mailing Address - Country:US
Mailing Address - Phone:518-834-6090
Mailing Address - Fax:518-834-7021
Practice Address - Street 1:1730 FRONT ST
Practice Address - Street 2:
Practice Address - City:KEESEVILLE
Practice Address - State:NY
Practice Address - Zip Code:12944-3618
Practice Address - Country:US
Practice Address - Phone:518-834-6090
Practice Address - Fax:518-834-7021
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042070183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY042070OtherPHARMACIST LICENSE