Provider Demographics
NPI:1932288529
Name:DALICANDRO, DANIELLE DOHERTY (PHARMACY TECHNICIAN)
Entity Type:Individual
Prefix:MISS
First Name:DANIELLE
Middle Name:DOHERTY
Last Name:DALICANDRO
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6024 N WEST CIRCLE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-2414
Mailing Address - Country:US
Mailing Address - Phone:773-792-0026
Mailing Address - Fax:
Practice Address - Street 1:7124 W HIGGINS AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60656-1904
Practice Address - Country:US
Practice Address - Phone:773-631-5333
Practice Address - Fax:772-732-1402
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician