Provider Demographics
NPI:1265847974
Name:MCDANIEL, ANTOINETTE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANTOINETTE
Middle Name:
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3915 AVALON AVE
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-3977
Mailing Address - Country:US
Mailing Address - Phone:817-683-8628
Mailing Address - Fax:
Practice Address - Street 1:3915 AVALON AVE
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-3977
Practice Address - Country:US
Practice Address - Phone:817-683-8628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35511183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist