Basic Information
| Provider Information | |||||||||
| NPI: | 1164695961 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WIERCINSKI | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 239 WELLINGTON RD | ||||||||
| Address2: | |||||||||
| City: | MINEOLA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115012419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5163855376 | ||||||||
| FaxNumber: | 5162940366 | ||||||||
| Practice Location | |||||||||
| Address1: | 1580 ROUTE 112 | ||||||||
| Address2: | |||||||||
| City: | MEDFORD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117633632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6312079234 | ||||||||
| FaxNumber: | 6312079502 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2008 | ||||||||
| LastUpdateDate: | 06/02/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 040076 | NY | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.