Provider Demographics
NPI:1679866180
Name:MORAN, DANIELLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:
Last Name:MORAN
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 1:1470 MARVIN RD NE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-3870
Mailing Address - Country:US
Mailing Address - Phone:360-412-3488
Mailing Address - Fax:360-412-3485
Practice Address - Street 1:1470 MARVIN RD NE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-3870
Practice Address - Country:US
Practice Address - Phone:360-412-3488
Practice Address - Fax:360-412-3485
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00056588183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist