Provider Demographics
NPI:1609287986
Name:DANIELS, THOMAS (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:DANIELS
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 E LAKE DR W
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-4210
Mailing Address - Country:US
Mailing Address - Phone:574-266-6018
Mailing Address - Fax:574-273-3465
Practice Address - Street 1:3600 NORTH PORTAGE RD.
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46628
Practice Address - Country:US
Practice Address - Phone:574-273-3410
Practice Address - Fax:574-273-3465
Is Sole Proprietor?:No
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26002089A1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy