Provider Demographics
NPI:1902470545
Name:STEWART, DANIEL (PHARMACY TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:STEWART
Suffix:
Gender:M
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6359 AVENIDA DE LAS VISTAS UNIT 5
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-6604
Mailing Address - Country:US
Mailing Address - Phone:619-251-1277
Mailing Address - Fax:
Practice Address - Street 1:4348 BONITA RD
Practice Address - Street 2:
Practice Address - City:BONITA
Practice Address - State:CA
Practice Address - Zip Code:91902-1421
Practice Address - Country:US
Practice Address - Phone:619-267-1617
Practice Address - Fax:619-261-1137
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19976183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician