Provider Demographics
NPI:1730712878
Name:NALL, DANIEL PRESTON
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:PRESTON
Last Name:NALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 LONG RUN RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-4357
Mailing Address - Country:US
Mailing Address - Phone:502-245-3053
Mailing Address - Fax:
Practice Address - Street 1:12501 SHELBYVILLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-1530
Practice Address - Country:US
Practice Address - Phone:502-244-7960
Practice Address - Fax:502-244-7982
Is Sole Proprietor?:No
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0104501835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist