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General NPI Number Information
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NPI Number | 1447693312
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Entity Type | Organization
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Legal Business Name | GLEN DANIEL PHARMACY
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Dates
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Enumeration Date | 04/10/2013
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Last Update Date | 04/10/2013
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Provider Practice Location Address
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Address Line | 6435C HARPER ROAD
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City | SURVEYOR
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State | WV
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Zip | 25932
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Country | US
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Telephone | 304-934-6337
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Fax | 304-934-6333
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Provider Business Mailing Address
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Address Line | PO BOX 230
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City | SURVEYOR
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State | WV
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Zip | 25932-0230
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Country | US
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Telephone | 304-934-6337
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Fax | 304-934-6333
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Authorized Official
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Title or Position | OWNER
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Name | MR. MELVIN STUART JAMISON
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Credential | RPH
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Telephone | 304-763-5112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 552447
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License Number State | WV
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