Provider Demographics
NPI:1578166674
Name:MCDANIEL, TERRANCE JALEEL (PHARMD)
Entity Type:Individual
Prefix:
First Name:TERRANCE
Middle Name:JALEEL
Last Name:MCDANIEL
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 1:11040 213TH ST
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11429-1816
Mailing Address - Country:US
Mailing Address - Phone:516-225-9614
Mailing Address - Fax:
Practice Address - Street 1:705 MIDDLETOWN WARWICK RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-9095
Practice Address - Country:US
Practice Address - Phone:302-449-0597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0005309183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist