Provider Demographics
NPI:1609284439
Name:NICKELL, DANIEL KEITH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:KEITH
Last Name:NICKELL
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 1:650 BEEBALM LN STE 220
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-2955
Mailing Address - Country:US
Mailing Address - Phone:615-687-3601
Mailing Address - Fax:
Practice Address - Street 1:650 BEEBALM LN STE 220
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-2955
Practice Address - Country:US
Practice Address - Phone:615-687-3601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-24
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62030183500000X
PARP452150183500000X
GARPH027986183500000X
KY019700183500000X
TN38150183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist