Provider Demographics
NPI:1407033657
Name:DAHULICH, DANIELLE LEA (RPH)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:LEA
Last Name:DAHULICH
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 1:1517 MAX WAY
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-3942
Mailing Address - Country:US
Mailing Address - Phone:845-440-6100
Mailing Address - Fax:
Practice Address - Street 1:986 MAIN ST
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-3507
Practice Address - Country:US
Practice Address - Phone:845-896-2067
Practice Address - Fax:845-896-6563
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051185183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02009745Medicaid