Provider Demographics
NPI:1568559417
Name:DANIEL, RICHARD JAY (RPH)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:JAY
Last Name:DANIEL
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 1:1925 E ROSEMEADE PKWY
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-2438
Mailing Address - Country:US
Mailing Address - Phone:972-492-4411
Mailing Address - Fax:972-492-4122
Practice Address - Street 1:1925 E ROSEMEADE PKWY
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-2438
Practice Address - Country:US
Practice Address - Phone:972-492-4411
Practice Address - Fax:972-492-4122
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21180183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist