MEDICARE: DR. KENNETH DONALD DANIELS BS,PHARMD

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	PS32977	FL

General Provider Information

NPI Number	:	1598106791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH DONALD DANIELS BS,PHARMD

Provider Business Mailing Address
First Line	:	4156 DUNMORE DR
Second Line	:
City	:	LAKE WALES
State	:	FL
Zip	:	33859-5742
Country	:	US
Telephone Number	:	863-949-4284
Fax Number	:	863-949-4286

Provider Business Practice Location Address
First Line	:	4156 DUNMORE DR
Second Line	:
City	:	LAKE WALES
State	:	FL
Zip	:	33859-5742
Country	:	US
Telephone Number	:	863-949-4284
Fax Number	:	863-949-4286

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

Provider Enumeration Date	:	07/16/2013
Last Update Date	:	07/16/2013

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