Provider Demographics
NPI:1366727950
Name:PRICE, DANIEL THOMAS (RPH)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:THOMAS
Last Name:PRICE
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 1:13992 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-4517
Mailing Address - Country:US
Mailing Address - Phone:636-227-9228
Mailing Address - Fax:
Practice Address - Street 1:13992 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-4517
Practice Address - Country:US
Practice Address - Phone:636-227-9228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-15
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO041263183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO041263OtherMISSOURI BOARD OF PHARMACY PHARMACIST