Provider Demographics
NPI:1114652245
Name:MAILE, DANICA ROSE (PHARMD)
Entity Type:Individual
Prefix:
First Name:DANICA
Middle Name:ROSE
Last Name:MAILE
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 1:27700 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-1506
Mailing Address - Country:US
Mailing Address - Phone:586-773-0500
Mailing Address - Fax:586-447-4362
Practice Address - Street 1:27700 HARPER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-1506
Practice Address - Country:US
Practice Address - Phone:586-773-0500
Practice Address - Fax:586-447-4362
Is Sole Proprietor?:No
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN125625183500000X
MI5302414439183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist