Provider Demographics
NPI:1518204569
Name:AULT, DANIEL E (RPH)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:E
Last Name:AULT
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 1:2095 HIGHWAY 211 NW
Mailing Address - Street 2:
Mailing Address - City:BRASELTON
Mailing Address - State:GA
Mailing Address - Zip Code:30517-3402
Mailing Address - Country:US
Mailing Address - Phone:678-425-6206
Mailing Address - Fax:678-425-6211
Practice Address - Street 1:2095 HIGHWAY 211 NW
Practice Address - Street 2:
Practice Address - City:BRASELTON
Practice Address - State:GA
Practice Address - Zip Code:30517-3402
Practice Address - Country:US
Practice Address - Phone:678-425-6206
Practice Address - Fax:678-425-6211
Is Sole Proprietor?:No
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH021876183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist