Provider Demographics
NPI:1104296359
Name:LUM, DANIEL MATTHEW (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:MATTHEW
Last Name:LUM
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 1:1005 SNOW LN
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-5278
Mailing Address - Country:US
Mailing Address - Phone:714-393-9817
Mailing Address - Fax:
Practice Address - Street 1:48 ROBERTSON BLVD
Practice Address - Street 2:
Practice Address - City:CHOWCHILLA
Practice Address - State:CA
Practice Address - Zip Code:93610-2928
Practice Address - Country:US
Practice Address - Phone:559-665-1096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72351183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist