Provider Demographics
NPI:1235292368
Name:DANIELS, WALTER CHARLES (RPH)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:CHARLES
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 1:15 E MARBLE ST
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-4258
Mailing Address - Country:US
Mailing Address - Phone:717-766-8291
Mailing Address - Fax:
Practice Address - Street 1:15 E MARBLE ST
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-4258
Practice Address - Country:US
Practice Address - Phone:717-766-8291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP023933L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist