Provider Demographics
NPI:1184956229
Name:HORN, DANIEL JOSEPH (RPH)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:JOSEPH
Last Name:HORN
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 1:111 E GREEN ST
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-3641
Mailing Address - Country:US
Mailing Address - Phone:716-376-6337
Mailing Address - Fax:716-372-2634
Practice Address - Street 1:111 E GREEN ST
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-3641
Practice Address - Country:US
Practice Address - Phone:716-376-6337
Practice Address - Fax:716-372-2634
Is Sole Proprietor?:No
Enumeration Date:2010-01-30
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030492183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01904916Medicaid
NY1242640001Medicare NSC