Provider Demographics
NPI:1508957549
Name:ARTHUR LEE DANIEL JR.
Entity Type:Organization
Organization Name:ARTHUR LEE DANIEL JR.
Other - Org Name:WEST VALLEY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:915-877-2124
Mailing Address - Street 1:6898 DONIPHAN
Mailing Address - Street 2:PO BOX 1410
Mailing Address - City:CANUTILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79835
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6898 DONIPHAN
Practice Address - Street 2:
Practice Address - City:CANUTILLO
Practice Address - State:TX
Practice Address - Zip Code:79835
Practice Address - Country:US
Practice Address - Phone:915-877-3124
Practice Address - Fax:915-877-1575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX068223336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM63321Medicaid
TX142310Medicaid
4564818OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NM63321Medicaid