Provider Demographics
NPI:1497358386
Name:DANIELS, AMY BETH (RPH)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:BETH
Last Name:DANIELS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6364A SPRINGFIELD PLZ
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-3431
Mailing Address - Country:US
Mailing Address - Phone:571-214-9176
Mailing Address - Fax:844-411-6515
Practice Address - Street 1:6364A SPRINGFIELD PLZ
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-3431
Practice Address - Country:US
Practice Address - Phone:703-569-5401
Practice Address - Fax:844-411-6515
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-21
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202011812183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist