Provider Demographics
NPI:1043413016
Name:DANIELS, CHARIS M
Entity Type:Individual
Prefix:MRS
First Name:CHARIS
Middle Name:M
Last Name:DANIELS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CHARIS
Other - Middle Name:M
Other - Last Name:HITZFIELD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 595
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:IN
Mailing Address - Zip Code:46792
Mailing Address - Country:US
Mailing Address - Phone:260-917-0146
Mailing Address - Fax:
Practice Address - Street 1:222 N WAYNE ST
Practice Address - Street 2:WARREN PHARMACY
Practice Address - City:WARREN
Practice Address - State:IN
Practice Address - Zip Code:46792
Practice Address - Country:US
Practice Address - Phone:260-375-2135
Practice Address - Fax:260-375-7030
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN67000312A183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician