Provider Demographics
NPI:1609076371
Name:SIDWELL, DANIEL LEE II (PHARMD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:LEE
Last Name:SIDWELL
Suffix:II
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 1:19626 HARL WEILLER RD
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43724-9149
Mailing Address - Country:US
Mailing Address - Phone:740-783-1187
Mailing Address - Fax:
Practice Address - Street 1:109 WEST ST
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:OH
Practice Address - Zip Code:43724-1359
Practice Address - Country:US
Practice Address - Phone:740-732-4503
Practice Address - Fax:740-732-2272
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-28021183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist