Provider Demographics
NPI:1861960700
Name:WATERS, DANIEL CRAIG
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:CRAIG
Last Name:WATERS
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 1:317 REAGAN CT
Mailing Address - Street 2:
Mailing Address - City:ROYSE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75189-6449
Mailing Address - Country:US
Mailing Address - Phone:903-356-2449
Mailing Address - Fax:903-356-4797
Practice Address - Street 1:733 E QUINLAN PKWY
Practice Address - Street 2:
Practice Address - City:QUINLAN
Practice Address - State:TX
Practice Address - Zip Code:75474-8641
Practice Address - Country:US
Practice Address - Phone:903-356-2449
Practice Address - Fax:903-356-4797
Is Sole Proprietor?:No
Enumeration Date:2018-11-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33146183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist