Provider Demographics
NPI:1013961200
Name:DANIELSON, MELANIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:DANIELSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:
Other - Last Name:MONNIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2000 E LAYTON AVE.
Mailing Address - Street 2:
Mailing Address - City:ST FRANCIS
Mailing Address - State:WI
Mailing Address - Zip Code:53235
Mailing Address - Country:US
Mailing Address - Phone:414-483-3800
Mailing Address - Fax:414-483-3284
Practice Address - Street 1:2000 E LAYTON AVE.
Practice Address - Street 2:
Practice Address - City:ST FRANCIS
Practice Address - State:WI
Practice Address - Zip Code:53235
Practice Address - Country:US
Practice Address - Phone:414-483-3800
Practice Address - Fax:414-483-3284
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117486-7183500000X
WI18179-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist