Provider Demographics
NPI:1760756787
Name:BEARDSLEY, DANIEL O (RPH)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:O
Last Name:BEARDSLEY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 SHASTA WAY
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-4455
Mailing Address - Country:US
Mailing Address - Phone:541-884-1780
Mailing Address - Fax:541-884-1762
Practice Address - Street 1:2655 SHASTA WAY
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-4455
Practice Address - Country:US
Practice Address - Phone:541-884-1780
Practice Address - Fax:541-884-1762
Is Sole Proprietor?:No
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK838183500000X
OR0011316183500000X
AZS006354183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist