Provider Demographics
NPI:1326196973
Name:DANIELS, CHARLES EDWARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:EDWARD
Last Name:DANIELS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WEST ARBOR DRIVE
Mailing Address - Street 2:PHARMACY DEPARTMENT MC8765
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-8765
Mailing Address - Country:US
Mailing Address - Phone:619-543-6194
Mailing Address - Fax:619-543-5829
Practice Address - Street 1:200 WEST ARBOR DRIVE
Practice Address - Street 2:PHARMACY DEPARTMENT MC8765
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-8765
Practice Address - Country:US
Practice Address - Phone:619-543-6194
Practice Address - Fax:619-543-5829
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29598183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist