Individual provider Active NPI

Bob Daniel

  • Pharmacist
  • Walla Walla, WA
National Provider Identifier
1205136579
Registry record updated Nov 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
PH00045289 Issued in WA
Practice address
1120 W Rose St
Walla Walla, WA 99362-1662
Phone
(509) 525-6695
Fax
(509) 522-2349
NPI assigned
Nov 2, 2010
Last updated
Nov 28, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X PH00045289 WA Primary

Addresses

Primary practice location

1120 W Rose St
Walla Walla, WA 99362-1662

Mailing address

1120 W Rose St
Walla Walla, WA 99362-1662
Phone (509) 525-6695

Other practice location 1

1600 Plaza Way
Walla Walla, WA 99362-4325
Phone (509) 522-4672

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
PH00045289WAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Safeway Inc Past Accepting new patients
Safeway Inc Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1288656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1511827200000",
    "number": "1205136579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 W ROSE ST",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993621662",
            "telephone_number": "509-525-6695",
            "fax_number": "509-522-2349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 W ROSE ST",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993621662",
            "telephone_number": "509-525-6695",
            "fax_number": "509-522-2349"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1600 Plaza Way",
            "address_purpose": "LOCATION",
            "city": "Walla Walla",
            "state": "WA",
            "postal_code": "993624325",
            "country_code": "US",
            "telephone_number": "509-522-4672",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DANIEL",
        "first_name": "BOB",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-11-02",
        "last_updated": "2017-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WA",
            "license": "PH00045289",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Walla Walla, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.