Provider Demographics
NPI:1982180865
Name:CRITCHELOE, DANIKA ROSE
Entity Type:Individual
Prefix:
First Name:DANIKA
Middle Name:ROSE
Last Name:CRITCHELOE
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 1:1A DOCUMENT DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63114-6110
Mailing Address - Country:US
Mailing Address - Phone:314-961-4405
Mailing Address - Fax:314-961-4010
Practice Address - Street 1:1A DOCUMENT DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63114-6110
Practice Address - Country:US
Practice Address - Phone:314-961-4405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-13
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016024007183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist