1396077426 NPI number — MR. DANIEL STEPHEN DREWNIAK PHARM.D.

Table of content: MR. DANIEL STEPHEN DREWNIAK PHARM.D. (NPI 1396077426)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396077426 NPI number — MR. DANIEL STEPHEN DREWNIAK PHARM.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DREWNIAK
Provider First Name:
DANIEL
Provider Middle Name:
STEPHEN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PHARM.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396077426
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2800 NAGLEE ROAD
Provider Second Line Business Mailing Address:
TARGET PHARMACY
Provider Business Mailing Address City Name:
TRACY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94597
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-833-0072
Provider Business Mailing Address Fax Number:
209-833-0072

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2800 NAGLEE RD
Provider Second Line Business Practice Location Address:
TARGET PHARMACY
Provider Business Practice Location Address City Name:
TRACY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95304-7307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-833-0072
Provider Business Practice Location Address Fax Number:
209-833-0072
Provider Enumeration Date:
01/29/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  PH232736 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: 64947 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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