Provider Demographics
NPI:1659673523
Name:DANIELS, TIA EDDY (PHARMD)
Entity Type:Individual
Prefix:
First Name:TIA
Middle Name:EDDY
Last Name:DANIELS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3971 BRAMBLETON AVE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-6402
Mailing Address - Country:US
Mailing Address - Phone:540-725-3808
Mailing Address - Fax:540-725-3812
Practice Address - Street 1:3971 BRAMBLETON AVE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-6402
Practice Address - Country:US
Practice Address - Phone:540-725-3808
Practice Address - Fax:540-725-3812
Is Sole Proprietor?:No
Enumeration Date:2010-11-29
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02022062731835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist