Provider Demographics
NPI:1558664441
Name:DAUGHERTY, DANIEL B
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:B
Last Name:DAUGHERTY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 WARDS RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-5310
Mailing Address - Country:US
Mailing Address - Phone:434-239-6727
Mailing Address - Fax:434-239-4025
Practice Address - Street 1:2012 WARDS RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-5310
Practice Address - Country:US
Practice Address - Phone:434-239-6727
Practice Address - Fax:434-239-4025
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202007465183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist