Provider Demographics
NPI:1013202175
Name:WAHL, DANIEL CARROLL (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:CARROLL
Last Name:WAHL
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 4TH ST SW
Mailing Address - Street 2:T-0804
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-1501
Mailing Address - Country:US
Mailing Address - Phone:641-423-1325
Mailing Address - Fax:
Practice Address - Street 1:3450 4TH ST SW
Practice Address - Street 2:T-0804
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-1501
Practice Address - Country:US
Practice Address - Phone:641-423-1325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21334183500000X
MN120065183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist