Provider Demographics
NPI:1548543432
Name:KRYZANEKAS, DANIEL ALEXANDER (RPH)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:ALEXANDER
Last Name:KRYZANEKAS
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 1:400 ROUTE 9
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08721-1223
Mailing Address - Country:US
Mailing Address - Phone:732-237-7142
Mailing Address - Fax:732-237-7148
Practice Address - Street 1:400 ROUTE 9
Practice Address - Street 2:
Practice Address - City:BAYVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08721-1223
Practice Address - Country:US
Practice Address - Phone:732-237-7142
Practice Address - Fax:732-237-7148
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02531400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist