Provider Demographics
NPI:1083189195
Name:LOYA-VENZOR, DANIEL I (PHARMD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:I
Last Name:LOYA-VENZOR
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 1:304 COOPER LN APT C
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-5927
Mailing Address - Country:US
Mailing Address - Phone:505-319-8648
Mailing Address - Fax:
Practice Address - Street 1:304 COOPER LN APT C
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5927
Practice Address - Country:US
Practice Address - Phone:505-319-8648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH79125183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist