Provider Demographics
NPI:1508872375
Name:DAUGHERTY, PATRICK WAYNE (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:WAYNE
Last Name:DAUGHERTY
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 1:611 CAMPUS DR STE 500
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-9701
Mailing Address - Country:US
Mailing Address - Phone:276-628-2001
Mailing Address - Fax:276-628-2514
Practice Address - Street 1:611 CAMPUS DR STE 500
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-9701
Practice Address - Country:US
Practice Address - Phone:276-628-2001
Practice Address - Fax:276-628-2514
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0201002592183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist