Provider Demographics
NPI:1770233538
Name:LETBETTER, DANIEL C
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:C
Last Name:LETBETTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292 FOX RUN LN
Mailing Address - Street 2:
Mailing Address - City:AUTRYVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28318-7313
Mailing Address - Country:US
Mailing Address - Phone:910-489-8713
Mailing Address - Fax:
Practice Address - Street 1:292 FOX RUN LN
Practice Address - Street 2:
Practice Address - City:AUTRYVILLE
Practice Address - State:NC
Practice Address - Zip Code:28318-7313
Practice Address - Country:US
Practice Address - Phone:910-489-8713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31093183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist