Provider Demographics
NPI:1053719112
Name:DANIEL, BRANDON NOEL (PHARMD)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:NOEL
Last Name:DANIEL
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 1:245 ROCKY CT
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-8441
Mailing Address - Country:US
Mailing Address - Phone:304-673-3500
Mailing Address - Fax:
Practice Address - Street 1:69 LEWIS STREET
Practice Address - Street 2:
Practice Address - City:WHITESVILLE
Practice Address - State:WV
Practice Address - Zip Code:25209
Practice Address - Country:US
Practice Address - Phone:304-854-2373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-05
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0008997183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist