Provider Demographics
NPI:1275136046
Name:FIEGEL, DANIEL KEITH
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:KEITH
Last Name:FIEGEL
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:PO BOX 3493
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73702-3493
Mailing Address - Country:US
Mailing Address - Phone:877-233-5260
Mailing Address - Fax:855-242-1155
Practice Address - Street 1:1119 E GARRIOTT RD STE A
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-6151
Practice Address - Country:US
Practice Address - Phone:877-233-5260
Practice Address - Fax:855-937-0798
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10147183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist