Provider Demographics
NPI:1073778882
Name:GRACI, DANIELLE M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:M
Last Name:GRACI
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 1:100 WILLOW PARK CENTER
Mailing Address - Street 2:T 1866
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11793
Mailing Address - Country:US
Mailing Address - Phone:631-962-0271
Mailing Address - Fax:631-962-0271
Practice Address - Street 1:100 WILLOW PARK CTR
Practice Address - Street 2:T 1866
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-1001
Practice Address - Country:US
Practice Address - Phone:631-962-0271
Practice Address - Fax:631-962-0271
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044391183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02531588Medicaid