Provider Demographics
NPI:1124151162
Name:CARPENTER, DANIEL E (RPH, BCNP)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:E
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:RPH, BCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 BELLE WOODS DR
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-1670
Mailing Address - Country:US
Mailing Address - Phone:860-633-1334
Mailing Address - Fax:
Practice Address - Street 1:628 HEBRON AVE BLDG 4
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-5017
Practice Address - Country:US
Practice Address - Phone:860-657-2520
Practice Address - Fax:860-633-9805
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT81621835N0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N0905XPharmacy Service ProvidersPharmacistNuclear