Provider Demographics
NPI:1285957290
Name:WHITE, DANIEL COUGHLIN (RPH)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:COUGHLIN
Last Name:WHITE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 ROTTERDAM DR
Mailing Address - Street 2:
Mailing Address - City:GLENMONT
Mailing Address - State:NY
Mailing Address - Zip Code:12077-3637
Mailing Address - Country:US
Mailing Address - Phone:518-767-2459
Mailing Address - Fax:
Practice Address - Street 1:7600 ROUTE 32
Practice Address - Street 2:
Practice Address - City:CAIRO
Practice Address - State:NY
Practice Address - Zip Code:12413
Practice Address - Country:US
Practice Address - Phone:518-622-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-04
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039785183500000X
CT7074183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist