Provider Demographics
NPI:1114214525
Name:GLAD, DANIEL
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:GLAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10025 E HIGHLAND RD
Mailing Address - Street 2:T-1977
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-1879
Mailing Address - Country:US
Mailing Address - Phone:810-632-2317
Mailing Address - Fax:810-632-2317
Practice Address - Street 1:10025 E HIGHLAND ROAD
Practice Address - Street 2:T-1977
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843
Practice Address - Country:US
Practice Address - Phone:810-632-2317
Practice Address - Fax:810-632-2317
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302032228183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist