Basic Information
| Provider Information | |||||||||
| NPI: | 1508867748 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DANNER | ||||||||
| FirstName: | JERRY | ||||||||
| MiddleName: | DON | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | RPH, CDE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3600 TYNDALE LN | ||||||||
| Address2: | |||||||||
| City: | AMARILLO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 791185057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8065704542 | ||||||||
| FaxNumber: | 8063547857 | ||||||||
| Practice Location | |||||||||
| Address1: | 6010 W AMARILLO BLVD | ||||||||
| Address2: | |||||||||
| City: | AMARILLO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 791061990 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8063547898 | ||||||||
| FaxNumber: | 8063547857 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P1200X | 18785 | TX | Y | Pharmacy Service Providers | Pharmacist | Pharmacotherapy |
No ID Information.