Provider Demographics
NPI:1225331085
Name:WEBER, DANIEL JAY (RPH)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:JAY
Last Name:WEBER
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 1:100 STONEWALL DR
Mailing Address - Street 2:
Mailing Address - City:DALEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24083-3183
Mailing Address - Country:US
Mailing Address - Phone:540-966-6469
Mailing Address - Fax:
Practice Address - Street 1:1618 MAIN ST
Practice Address - Street 2:
Practice Address - City:CLIFTON FORGE
Practice Address - State:VA
Practice Address - Zip Code:24422-1904
Practice Address - Country:US
Practice Address - Phone:540-863-0074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202206342183500000X
AZ009595183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist