MEDICARE: CLINT DANIEL RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PST.016908	LA

General Provider Information

NPI Number	:	1528991130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLINT DANIEL RPH

Provider Business Mailing Address
First Line	:	2810 COMMON ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-7350
Country	:	US
Telephone Number	:	337-602-1417
Fax Number	:	337-564-3029

Provider Business Practice Location Address
First Line	:	2810 COMMON ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-7350
Country	:	US
Telephone Number	:	337-602-1417
Fax Number	:	337-564-3029

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2026
Last Update Date	:	06/04/2026

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