Provider Demographics
NPI:1255445615
Name:DANIEL, MARSHA JACQUELINE (PHARMD, CPH, CDE)
Entity type:Individual
Prefix:DR
First Name:MARSHA
Middle Name:JACQUELINE
Last Name:DANIEL
Suffix:
Gender:F
Credentials:PHARMD, CPH, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1398 NW 126TH WAY
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-3198
Mailing Address - Country:US
Mailing Address - Phone:954-257-7299
Mailing Address - Fax:754-223-7077
Practice Address - Street 1:3100 WESTON RD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3602
Practice Address - Country:US
Practice Address - Phone:954-689-5280
Practice Address - Fax:954-689-5281
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPU 6345183500000X
FLPS 41501183500000X
FL2011-0278174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No174H00000XOther Service ProvidersHealth Educator