Provider Demographics
NPI:1497129498
Name:OKERBLOM, DANIELLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:OKERBLOM
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 1:517 CAROL PL
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-3713
Mailing Address - Country:US
Mailing Address - Phone:805-478-4994
Mailing Address - Fax:
Practice Address - Street 1:517 CAROL PL
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-3713
Practice Address - Country:US
Practice Address - Phone:805-478-4994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-15
Last Update Date:2015-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73942183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist