Provider Demographics
NPI:1770815383
Name:VENABLE, DANIEL RUSSELL
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:RUSSELL
Last Name:VENABLE
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 1:502 LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-3310
Mailing Address - Country:US
Mailing Address - Phone:716-490-0778
Mailing Address - Fax:
Practice Address - Street 1:1376 E 2ND ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-1948
Practice Address - Country:US
Practice Address - Phone:716-483-6913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-06
Last Update Date:2010-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041884183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist