Provider Demographics
NPI:1861642308
Name:BARNES, DARYL M (RPH)
Entity Type:Individual
Prefix:
First Name:DARYL
Middle Name:M
Last Name:BARNES
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 1:4300 LEONARD RD
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-9255
Mailing Address - Country:US
Mailing Address - Phone:541-761-9357
Mailing Address - Fax:
Practice Address - Street 1:4300 LEONARD RD
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-9255
Practice Address - Country:US
Practice Address - Phone:541-761-9357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-20
Last Update Date:2008-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8882183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist