Provider Demographics
NPI:1689043705
Name:JACOBS-WOODWARD, DANIELLE RENEE (CPHT,RPHT)
Entity Type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:RENEE
Last Name:JACOBS-WOODWARD
Suffix:
Gender:F
Credentials:CPHT,RPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8138 E VERNOR HWY
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48214-2641
Mailing Address - Country:US
Mailing Address - Phone:313-402-6657
Mailing Address - Fax:586-757-7785
Practice Address - Street 1:22835 VAN DYKE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089
Practice Address - Country:US
Practice Address - Phone:586-757-6505
Practice Address - Fax:586-757-7785
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-18
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5303000537183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician