Provider Demographics
NPI:1932485935
Name:DANIELS, ANGELA WALLS
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:WALLS
Last Name:DANIELS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3735 RENEE DR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-4109
Mailing Address - Country:US
Mailing Address - Phone:843-236-4296
Mailing Address - Fax:843-236-4274
Practice Address - Street 1:3735 RENEE DR
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-4109
Practice Address - Country:US
Practice Address - Phone:843-236-4296
Practice Address - Fax:843-236-4274
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10902183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist