Provider Demographics
NPI:1487070371
Name:FAUSEL, DANIEL KASPER
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:KASPER
Last Name:FAUSEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DANIEL
Other - Middle Name:K
Other - Last Name:FAUSEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:359 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-5605
Mailing Address - Country:US
Mailing Address - Phone:530-622-3186
Mailing Address - Fax:530-622-3224
Practice Address - Street 1:359 MAIN ST
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-5605
Practice Address - Country:US
Practice Address - Phone:530-622-3186
Practice Address - Fax:530-622-3224
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-15
Last Update Date:2014-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27872183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist