Provider Demographics
NPI:1053455683
Name:VINES, DANIEL RAY
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:RAY
Last Name:VINES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1280 HUEYTOWN RD
Mailing Address - Street 2:
Mailing Address - City:HUEYTOWN
Mailing Address - State:AL
Mailing Address - Zip Code:35023-2602
Mailing Address - Country:US
Mailing Address - Phone:205-491-2805
Mailing Address - Fax:
Practice Address - Street 1:1280 HUEYTOWN RD
Practice Address - Street 2:
Practice Address - City:HUEYTOWN
Practice Address - State:AL
Practice Address - Zip Code:35023-2602
Practice Address - Country:US
Practice Address - Phone:205-491-2805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15544183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist