Provider Demographics
NPI:1235307513
Name:FENNEMA, DANIELLE PAULINE (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:PAULINE
Last Name:FENNEMA
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 1:750 W HIGH ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801
Mailing Address - Country:US
Mailing Address - Phone:419-227-7399
Mailing Address - Fax:419-225-9610
Practice Address - Street 1:750 W HIGH ST
Practice Address - Street 2:SUITE 250
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801
Practice Address - Country:US
Practice Address - Phone:419-227-7399
Practice Address - Fax:419-225-9610
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03227901183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist