Provider Demographics
NPI:1013358506
Name:DANIELSON, STACIE RIKA (PHARMD)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:RIKA
Last Name:DANIELSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5324 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85034-2144
Mailing Address - Country:US
Mailing Address - Phone:602-732-3384
Mailing Address - Fax:602-732-3394
Practice Address - Street 1:4965 W BELL RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-3418
Practice Address - Country:US
Practice Address - Phone:602-843-2305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-11
Last Update Date:2013-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS019871183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist