Provider Demographics
NPI:1053190603
Name:DANIELS, ERIC JOHN (RPH)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:JOHN
Last Name:DANIELS
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 1:229 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT MARIES
Mailing Address - State:ID
Mailing Address - Zip Code:83861-1803
Mailing Address - Country:US
Mailing Address - Phone:530-240-5829
Mailing Address - Fax:
Practice Address - Street 1:229 S 7TH ST
Practice Address - Street 2:
Practice Address - City:SAINT MARIES
Practice Address - State:ID
Practice Address - Zip Code:83861-1803
Practice Address - Country:US
Practice Address - Phone:208-245-7687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID2261177183500000X
CA88477183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist