Provider Demographics
NPI:1821693151
Name:MCDANIEL, JOHN JASON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JASON
Last Name:MCDANIEL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILMORE
Mailing Address - State:KY
Mailing Address - Zip Code:40390-1321
Mailing Address - Country:US
Mailing Address - Phone:859-858-2453
Mailing Address - Fax:859-858-2436
Practice Address - Street 1:201 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WILMORE
Practice Address - State:KY
Practice Address - Zip Code:40390-1321
Practice Address - Country:US
Practice Address - Phone:859-858-2453
Practice Address - Fax:859-858-2436
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY012705183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist