Provider Demographics
NPI:1245510361
Name:MCDANIEL, MICHAEL DAVID (RPH)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAVID
Last Name:MCDANIEL
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 1:235 HIGHWAY 15/401 BYPASS
Mailing Address - Street 2:
Mailing Address - City:BENNETTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29512-3105
Mailing Address - Country:US
Mailing Address - Phone:843-479-7251
Mailing Address - Fax:843-479-3052
Practice Address - Street 1:235 HIGHWAY 15/401 BYPASS
Practice Address - Street 2:
Practice Address - City:BENNETTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29512-3105
Practice Address - Country:US
Practice Address - Phone:843-479-7251
Practice Address - Fax:843-479-3052
Is Sole Proprietor?:No
Enumeration Date:2011-08-20
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4972183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist