Provider Demographics
NPI:1366744864
Name:HARKINS, DANIEL BRADFORD (RPH)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:BRADFORD
Last Name:HARKINS
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 1:1597 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25311-2034
Mailing Address - Country:US
Mailing Address - Phone:304-400-4044
Mailing Address - Fax:
Practice Address - Street 1:10635 MACCORKLE AVE
Practice Address - Street 2:KROGER PHARMACY 754
Practice Address - City:MARMET
Practice Address - State:WV
Practice Address - Zip Code:25315
Practice Address - Country:US
Practice Address - Phone:304-949-3045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-03
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP00003905183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist