Basic Information
| Provider Information | |||||||||
| NPI: | 1346319043 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MIMS | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | ROY | ||||||||
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| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 INTERSTATE PARK DR | ||||||||
| Address2: | SUITE 422 | ||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361095428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3343567627 | ||||||||
| FaxNumber: | 3343567647 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 INTERSTATE PARK DR | ||||||||
| Address2: | SUITE 422 | ||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361095428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3343567627 | ||||||||
| FaxNumber: | 3343567647 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 13854 | AL | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.