Provider Demographics
NPI:1447540737
Name:DEEL, DAVID J (PHARMD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:DEEL
Suffix:
Gender:M
Credentials:PHARMD
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 1309
Mailing Address - Street 2:
Mailing Address - City:CLINTWOOD
Mailing Address - State:VA
Mailing Address - Zip Code:24228-1309
Mailing Address - Country:US
Mailing Address - Phone:276-926-6555
Mailing Address - Fax:276-926-6602
Practice Address - Street 1:HWY 83 AND BRUSH CREEK
Practice Address - Street 2:
Practice Address - City:CLINTWOOD
Practice Address - State:VA
Practice Address - Zip Code:24228-1309
Practice Address - Country:US
Practice Address - Phone:276-926-6555
Practice Address - Fax:276-926-6602
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA00202207417183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist