Provider Demographics
NPI:1497982730
Name:ETLING, DANIELLE LEE (RPH)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:LEE
Last Name:ETLING
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 1:166 ZITNEY RD
Mailing Address - Street 2:
Mailing Address - City:VANDERBILT
Mailing Address - State:PA
Mailing Address - Zip Code:15486
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:802 VANDERBILT RD
Practice Address - Street 2:
Practice Address - City:CONNELLSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15425-6241
Practice Address - Country:US
Practice Address - Phone:724-626-1091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-13
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP044351L183500000X
WVRP0006550183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist