Provider Demographics
NPI:1346319043
Name:MIMS, DANIEL ROY (RPH)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ROY
Last Name:MIMS
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 1:400 INTERSTATE PARK DR
Mailing Address - Street 2:SUITE 422
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36109-5428
Mailing Address - Country:US
Mailing Address - Phone:334-356-7627
Mailing Address - Fax:334-356-7647
Practice Address - Street 1:400 INTERSTATE PARK DR
Practice Address - Street 2:SUITE 422
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36109-5428
Practice Address - Country:US
Practice Address - Phone:334-356-7627
Practice Address - Fax:334-356-7647
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13854183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist