Provider Demographics
NPI:1679146757
Name:IMMEL, DANIELLE NICOLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:NICOLE
Last Name:IMMEL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:NICOLE
Other - Last Name:SHIVELY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:328 S WATER ST
Mailing Address - Street 2:
Mailing Address - City:UHRICHSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44683-1967
Mailing Address - Country:US
Mailing Address - Phone:330-432-0640
Mailing Address - Fax:
Practice Address - Street 1:832 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ORRVILLE
Practice Address - State:OH
Practice Address - Zip Code:44667-2208
Practice Address - Country:US
Practice Address - Phone:330-684-4781
Practice Address - Fax:330-684-4766
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03439754183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist