Provider Demographics
NPI:1588944136
Name:ANDRIACCO, DANIEL M JR (RPH)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:M
Last Name:ANDRIACCO
Suffix:JR
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 1:5941 BEECHTOP DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45233-4924
Mailing Address - Country:US
Mailing Address - Phone:513-922-3512
Mailing Address - Fax:513-347-3359
Practice Address - Street 1:2320 BOUDINOT AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-3417
Practice Address - Country:US
Practice Address - Phone:513-347-3359
Practice Address - Fax:513-347-3369
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03324122183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist