Healthcare Provider Details

I. General information

NPI: 1659489490
Provider Name (Legal Business Name): DANIEL MICHAEL TOOTLE RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 E LONG ST
CLAXTON GA
30417-1411
US

IV. Provider business mailing address

PO BOX 577
CLAXTON GA
30417-0577
US

V. Phone/Fax

Practice location:
  • Phone: 912-739-9393
  • Fax: 912-739-9033
Mailing address:
  • Phone: 912-739-9393
  • Fax: 912-739-9033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12310
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: