Provider Demographics
NPI:1750072591
Name:DANIELS, RICHARD C (PHARMD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:C
Last Name:DANIELS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1172 DEER HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:DEER LODGE
Mailing Address - State:MT
Mailing Address - Zip Code:59722-9409
Mailing Address - Country:US
Mailing Address - Phone:406-546-7531
Mailing Address - Fax:
Practice Address - Street 1:58 GARNET WAY
Practice Address - Street 2:
Practice Address - City:WARM SPRINGS
Practice Address - State:MT
Practice Address - Zip Code:59756-9704
Practice Address - Country:US
Practice Address - Phone:406-693-7175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPHA-PHA-LIC-546291835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatricGroup - Single Specialty