Provider Demographics
NPI:1093377962
Name:RODEWALD, DANIELLE E (PHARMD)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:E
Last Name:RODEWALD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:E
Other - Last Name:BROWNLEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:9621 S LOWELL RD
Mailing Address - Street 2:
Mailing Address - City:DEWITT
Mailing Address - State:MI
Mailing Address - Zip Code:48820-8087
Mailing Address - Country:US
Mailing Address - Phone:517-282-3624
Mailing Address - Fax:
Practice Address - Street 1:901 S OAKLAND ST
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:MI
Practice Address - Zip Code:48879-2200
Practice Address - Country:US
Practice Address - Phone:989-224-8155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302036935183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist