Healthcare Provider Details

I. General information

NPI: 1871233320
Provider Name (Legal Business Name): DANIEL EDGAR PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 SW 20TH ST STE 1
PENDLETON OR
97801-1864
US

IV. Provider business mailing address

PO BOX 1896
PENDLETON OR
97801-0947
US

V. Phone/Fax

Practice location:
  • Phone: 541-278-4285
  • Fax: 541-278-4288
Mailing address:
  • Phone: 775-343-8737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH-0019507
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH-0019507
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: