Provider Demographics
NPI:1386873065
Name:TOMASZEWSKI, DANIEL MARK (PHARMD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:MARK
Last Name:TOMASZEWSKI
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 1:1110 KIRBY DR
Mailing Address - Street 2:130 LIFE SCIENCE
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55812-3003
Mailing Address - Country:US
Mailing Address - Phone:218-726-6050
Mailing Address - Fax:218-726-6500
Practice Address - Street 1:1110 KIRBY DR
Practice Address - Street 2:130 LIFE SCIENCE
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55812-3003
Practice Address - Country:US
Practice Address - Phone:218-726-6050
Practice Address - Fax:218-726-6500
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI339952183500000X
MN119626183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI339952OtherPHARMACIST LICENSE
MN119626OtherPHARMACIST LICENSE