Provider Demographics
NPI:1932806643
Name:FENWICK, DANIEL M (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:M
Last Name:FENWICK
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5103 E KELTON LN
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-1059
Mailing Address - Country:US
Mailing Address - Phone:602-618-0155
Mailing Address - Fax:
Practice Address - Street 1:6825 W GALVESTON ST STE 3
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-2517
Practice Address - Country:US
Practice Address - Phone:480-718-0774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS010238183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZS010238OtherAZ PHARMACIST LICENSE