Provider Demographics
NPI:1043584162
Name:DANIEL, DILIP JOHN (PHARMD)
Entity type:Individual
Prefix:
First Name:DILIP
Middle Name:JOHN
Last Name:DANIEL
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 1:107 CLIFFWOOD RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-2714
Mailing Address - Country:US
Mailing Address - Phone:267-303-2719
Mailing Address - Fax:
Practice Address - Street 1:17239 FIVE POINTS SQ
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-1699
Practice Address - Country:US
Practice Address - Phone:302-644-7840
Practice Address - Fax:302-644-7844
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0004154183500000X
PARP444503183500000X
NJ28RI03352500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist