MEDICARE: ANGELA WALLS DANIELS

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	10902	SC

General Provider Information

NPI Number	:	1932485935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA WALLS DANIELS

Provider Business Mailing Address
First Line	:	3735 RENEE DR
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-4109
Country	:	US
Telephone Number	:	843-236-4296
Fax Number	:	843-236-4274

Provider Business Practice Location Address
First Line	:	3735 RENEE DR
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-4109
Country	:	US
Telephone Number	:	843-236-4296
Fax Number	:	843-236-4274

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

Provider Enumeration Date	:	10/24/2011
Last Update Date	:	10/24/2011

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