Provider Demographics
NPI:1649364282
Name:SMITH, DANIEL JORDAN (RPH)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:JORDAN
Last Name:SMITH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:814 EDGEHILL PLACE
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015
Mailing Address - Country:US
Mailing Address - Phone:269-964-6591
Mailing Address - Fax:
Practice Address - Street 1:DEPT OF VETERANS AFFAIRS MEDICAL HOSPITAL
Practice Address - Street 2:5500 ARMSTRONG ROAD
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49016
Practice Address - Country:US
Practice Address - Phone:269-966-5600
Practice Address - Fax:269-660-6025
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302022735183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist