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General NPI Number Information
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NPI Number | 1023148632
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Entity Type | Organization
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Legal Business Name | TERRY R DANIELS
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 01/05/2009
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Provider Practice Location Address
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Address Line | 222 N WAYNE ST
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City | WARREN
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State | IN
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Zip | 46792-0345
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Country | US
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Telephone | 260-375-2135
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 345
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City | WARREN
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State | IN
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Zip | 46792-0345
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Country | US
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Telephone | 260-375-2135
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Fax |
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Authorized Official
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Title or Position | OWNER PHARMACIST SECRETARY JANITOR
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Name | DR. TERRY R DANIELS
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Credential | PD MDIV
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Telephone | 260-375-2135
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 60004799A
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License Number State | IN
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