Provider Demographics
NPI:1306452446
Name:LARUE, DANIEL THANE (RPH)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:THANE
Last Name:LARUE
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 1:235 VIREO DR
Mailing Address - Street 2:
Mailing Address - City:WINTERSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43953-4068
Mailing Address - Country:US
Mailing Address - Phone:740-317-1972
Mailing Address - Fax:
Practice Address - Street 1:2217 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-2468
Practice Address - Country:US
Practice Address - Phone:740-264-5562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0004726183500000X
OH03-3-16097183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist