Provider Demographics
NPI:1902925811
Name:HORTON, MARK DANIEL (RPH)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:DANIEL
Last Name:HORTON
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 1:588 E MONROE RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-9456
Mailing Address - Country:US
Mailing Address - Phone:989-687-9108
Mailing Address - Fax:
Practice Address - Street 1:2910 ASHMAN ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-4448
Practice Address - Country:US
Practice Address - Phone:989-631-0700
Practice Address - Fax:989-631-0708
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302031986183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist