Provider Demographics
NPI:1073267555
Name:KIDANE, DANIEL G (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:G
Last Name:KIDANE
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 1:10966 STAGS LEAP CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-8738
Mailing Address - Country:US
Mailing Address - Phone:617-285-3106
Mailing Address - Fax:
Practice Address - Street 1:3400 VIRGINIA PKWY
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-3405
Practice Address - Country:US
Practice Address - Phone:214-250-5006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45665183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist