Provider Demographics
NPI:1063012391
Name:DAIDONE, CONNIE (RPH)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:DAIDONE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6955 MILLER LN
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-2658
Mailing Address - Country:US
Mailing Address - Phone:937-415-0198
Mailing Address - Fax:937-415-1691
Practice Address - Street 1:6955 MILLER LN
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-2658
Practice Address - Country:US
Practice Address - Phone:937-415-0198
Practice Address - Fax:937-415-1691
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03213196183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist