Provider Demographics
NPI:1093078933
Name:FAY, DANIELLE (PHARM D)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:FAY
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5315 E LAKE BOSWORTH DR
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-7793
Mailing Address - Country:US
Mailing Address - Phone:425-327-2765
Mailing Address - Fax:
Practice Address - Street 1:17520 SR 9
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98296-8320
Practice Address - Country:US
Practice Address - Phone:360-668-2012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60150427183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist