Provider Demographics
NPI:1407454754
Name:DANIELS, CASEY ANDREW (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CASEY
Middle Name:ANDREW
Last Name:DANIELS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 ROUND HILL RD
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-6507
Mailing Address - Country:US
Mailing Address - Phone:276-632-2129
Mailing Address - Fax:
Practice Address - Street 1:103 COMMONWEALTH BLVD W
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-1806
Practice Address - Country:US
Practice Address - Phone:276-632-6457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202219137183500000X
WVRP0012321183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist