Healthcare Provider Details

I. General information

NPI: 1508957549
Provider Name (Legal Business Name): ARTHUR LEE DANIEL JR.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 06/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6898 DONIPHAN
CANUTILLO TX
79835
US

IV. Provider business mailing address

6898 DONIPHAN PO BOX 1410
CANUTILLO TX
79835
US

V. Phone/Fax

Practice location:
  • Phone: 915-877-3124
  • Fax: 915-877-1575
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number06822
License Number StateTX

VIII. Authorized Official

Name: ARTHUR DANIEL
Title or Position: OWNER
Credential: RPH
Phone: 915-877-2124