Provider Demographics
NPI:1366512204
Name:ATWELL, DANIEL ROGER (RPH)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:ROGER
Last Name:ATWELL
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:PO BOX 338
Mailing Address - Street 2:1003 DOGWOOD AVENUE
Mailing Address - City:GROTTOES
Mailing Address - State:VA
Mailing Address - Zip Code:24441-0338
Mailing Address - Country:US
Mailing Address - Phone:540-249-0431
Mailing Address - Fax:
Practice Address - Street 1:1003 DOGWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:GROTTOES
Practice Address - State:VA
Practice Address - Zip Code:24441-0338
Practice Address - Country:US
Practice Address - Phone:540-249-0431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202006578183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist