Provider Demographics
NPI:1053667048
Name:DANIELS, DONALD RAY (RPH)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:RAY
Last Name:DANIELS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CAPTAINS CT
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-6224
Mailing Address - Country:US
Mailing Address - Phone:252-339-5240
Mailing Address - Fax:252-756-1623
Practice Address - Street 1:103 GREENVILLE BLVD SE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5707
Practice Address - Country:US
Practice Address - Phone:252-756-1611
Practice Address - Fax:252-756-1623
Is Sole Proprietor?:No
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11907183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0745945Medicaid