Provider Demographics
NPI:1023782372
Name:DUDA, DANIEL LEE JR (PHARMD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:LEE
Last Name:DUDA
Suffix:JR
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 1:975 MANHATTAN BLVD APT 3405
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:KY
Mailing Address - Zip Code:41074-7509
Mailing Address - Country:US
Mailing Address - Phone:513-939-5726
Mailing Address - Fax:
Practice Address - Street 1:260 STETSON ST STE F
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-5000
Practice Address - Country:US
Practice Address - Phone:513-878-3426
Practice Address - Fax:513-878-3428
Is Sole Proprietor?:No
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY022202183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist