Provider Demographics
NPI:1770963373
Name:MCDANIEL, MICHAEL (RPH)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
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 1:2252 SW 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-3965
Mailing Address - Country:US
Mailing Address - Phone:785-235-8796
Mailing Address - Fax:785-235-1939
Practice Address - Street 1:2252 SW 10TH AVE
Practice Address - Street 2:STORMONT-VAIL RETAIL PHARMACY
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-3965
Practice Address - Country:US
Practice Address - Phone:785-235-8796
Practice Address - Fax:785-235-1939
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-11364183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100443290AMedicaid