Provider Demographics
NPI:1033512652
Name:TATUSKO, DANIELLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:TATUSKO
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 1:10575 LANSFORD LN
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-5902
Mailing Address - Country:US
Mailing Address - Phone:315-430-8010
Mailing Address - Fax:
Practice Address - Street 1:8694 LAKE MURRAY BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92119-2828
Practice Address - Country:US
Practice Address - Phone:619-460-5978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-28
Last Update Date:2014-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA71516183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist