Provider Demographics
NPI:1861743528
Name:PROPHETE, DANIEL (PHARMD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:PROPHETE
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 1:8518 MILANO DR
Mailing Address - Street 2:2027
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-7005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8518 MILANO DR
Practice Address - Street 2:2027
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-7005
Practice Address - Country:US
Practice Address - Phone:321-439-6441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS42329183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist