Provider Demographics
NPI:1043320013
Name:DANIELS, RUSSELL E (RPH,MED,FASCP)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:E
Last Name:DANIELS
Suffix:
Gender:M
Credentials:RPH,MED,FASCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1265
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-1265
Mailing Address - Country:US
Mailing Address - Phone:717-503-6066
Mailing Address - Fax:
Practice Address - Street 1:512 BRINKER AVE
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-1535
Practice Address - Country:US
Practice Address - Phone:717-503-6066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP036576L1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy