Provider Demographics
NPI:1265791719
Name:SROKA, DANIELLE ELAINE
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:ELAINE
Last Name:SROKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DANI
Other - Middle Name:
Other - Last Name:SROKA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1407 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-3854
Mailing Address - Country:US
Mailing Address - Phone:206-726-3495
Mailing Address - Fax:206-726-3498
Practice Address - Street 1:1407 BROADWAY
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-3854
Practice Address - Country:US
Practice Address - Phone:206-726-3495
Practice Address - Fax:206-726-3498
Is Sole Proprietor?:No
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA60186176183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician