Provider Demographics
NPI:1861743015
Name:LITTLE, DANIEL LEE (RPH)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:LEE
Last Name:LITTLE
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 1:29315 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92532-2212
Mailing Address - Country:US
Mailing Address - Phone:951-253-6039
Mailing Address - Fax:951-253-6036
Practice Address - Street 1:29315 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92532-2212
Practice Address - Country:US
Practice Address - Phone:951-253-6039
Practice Address - Fax:951-253-6036
Is Sole Proprietor?:No
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29221183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist