Provider Demographics
NPI:1285929091
Name:BOATWRIGHT, DAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DAN
Middle Name:
Last Name:BOATWRIGHT
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 1:1515 E WARNER RD
Mailing Address - Street 2:T-1209
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-3138
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1515 E WARNER RD
Practice Address - Street 2:T-1209
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-3138
Practice Address - Country:US
Practice Address - Phone:480-892-1348
Practice Address - Fax:480-892-1348
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS011200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist