Provider Demographics
NPI:1063694313
Name:DRIER, DANIEL PATRICK (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:PATRICK
Last Name:DRIER
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 N. MILL ST.
Mailing Address - Street 2:P.O. BOX 190
Mailing Address - City:LA FARGE
Mailing Address - State:WI
Mailing Address - Zip Code:54639-0190
Mailing Address - Country:US
Mailing Address - Phone:608-625-2552
Mailing Address - Fax:608-625-2553
Practice Address - Street 1:206 N. MILL ST.
Practice Address - Street 2:
Practice Address - City:LA FARGE
Practice Address - State:WI
Practice Address - Zip Code:54639
Practice Address - Country:US
Practice Address - Phone:608-625-2552
Practice Address - Fax:608-625-2553
Is Sole Proprietor?:No
Enumeration Date:2007-11-28
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14225-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist