Provider Demographics
NPI:1871883108
Name:NYGREN, DANIEL ALBERT (RPH)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:ALBERT
Last Name:NYGREN
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 1:2 KIRBY AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN TOP
Mailing Address - State:PA
Mailing Address - Zip Code:18707-1213
Mailing Address - Country:US
Mailing Address - Phone:570-403-1132
Mailing Address - Fax:
Practice Address - Street 1:2 KIRBY AVE
Practice Address - Street 2:
Practice Address - City:MOUNTAIN TOP
Practice Address - State:PA
Practice Address - Zip Code:18707-1213
Practice Address - Country:US
Practice Address - Phone:570-403-1132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP441059183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist