Provider Demographics
NPI:1215401922
Name:DANIELS, SHAWNA LYNN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SHAWNA
Middle Name:LYNN
Last Name:DANIELS
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 1:8093 N CORNERSTONE DR
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-8753
Mailing Address - Country:US
Mailing Address - Phone:208-762-9355
Mailing Address - Fax:208-762-9198
Practice Address - Street 1:8093 N CORNERSTONE DR
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-8753
Practice Address - Country:US
Practice Address - Phone:208-762-9355
Practice Address - Fax:208-762-9198
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP5560183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist