Provider Demographics
NPI:1679172076
Name:LUNSFORD, DANIEL (PD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:LUNSFORD
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 TOWSON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-5099
Mailing Address - Country:US
Mailing Address - Phone:479-782-9210
Mailing Address - Fax:
Practice Address - Street 1:1112 TOWSON AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-5099
Practice Address - Country:US
Practice Address - Phone:479-782-9210
Practice Address - Fax:479-782-0023
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR08821183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist