Provider Demographics
NPI:1598106791
Name:DANIELS, KENNETH DONALD (BS,PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:DONALD
Last Name:DANIELS
Suffix:
Gender:M
Credentials:BS,PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4156 DUNMORE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33859-5742
Mailing Address - Country:US
Mailing Address - Phone:863-949-4284
Mailing Address - Fax:863-949-4286
Practice Address - Street 1:4156 DUNMORE DR
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33859-5742
Practice Address - Country:US
Practice Address - Phone:863-949-4284
Practice Address - Fax:863-949-4286
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS32977183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist