Provider Demographics
NPI:1659937282
Name:DEMEGILLO, DANIELLE KRISTINE
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:KRISTINE
Last Name:DEMEGILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S RACHAL ST
Mailing Address - Street 2:
Mailing Address - City:SINTON
Mailing Address - State:TX
Mailing Address - Zip Code:78387-2524
Mailing Address - Country:US
Mailing Address - Phone:361-364-1416
Mailing Address - Fax:361-364-5028
Practice Address - Street 1:200 S RACHAL ST
Practice Address - Street 2:
Practice Address - City:SINTON
Practice Address - State:TX
Practice Address - Zip Code:78387-2524
Practice Address - Country:US
Practice Address - Phone:361-364-1416
Practice Address - Fax:361-364-5028
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX58897183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty