Provider Demographics
NPI:1922397801
Name:MCDANIEL, LINDA C, (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:C,
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1664 HAMPTON OAKS BND
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-4451
Mailing Address - Country:US
Mailing Address - Phone:770-565-5455
Mailing Address - Fax:
Practice Address - Street 1:4283 WADE GREEN RD NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-1244
Practice Address - Country:US
Practice Address - Phone:770-422-0904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA015551183500000X
AL7113183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist