Provider Demographics
NPI:1417548637
Name:TULLY, DANIELLE (RPH)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:
Last Name:TULLY
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 1:2 CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:WEST JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28694-7375
Mailing Address - Country:US
Mailing Address - Phone:336-246-2790
Mailing Address - Fax:
Practice Address - Street 1:2 CRESCENT DR
Practice Address - Street 2:
Practice Address - City:WEST JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28694-7375
Practice Address - Country:US
Practice Address - Phone:336-246-2790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-30
Last Update Date:2021-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30190183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist