Provider Demographics
NPI:1629100375
Name:DANIELS, TERRY R (PD MDIV)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:R
Last Name:DANIELS
Suffix:
Gender:M
Credentials:PD MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 345
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:IN
Mailing Address - Zip Code:46792-0345
Mailing Address - Country:US
Mailing Address - Phone:260-375-2135
Mailing Address - Fax:
Practice Address - Street 1:222 N WAYNE ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:IN
Practice Address - Zip Code:46792-0345
Practice Address - Country:US
Practice Address - Phone:260-375-2135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26091932A183500000X
NY031585-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist