Provider Demographics
NPI:1336802099
Name:DANILENKO, DARIA DENISOVNA
Entity Type:Individual
Prefix:
First Name:DARIA
Middle Name:DENISOVNA
Last Name:DANILENKO
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 1:4567 OAK SHORES DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-7352
Mailing Address - Country:US
Mailing Address - Phone:469-919-1951
Mailing Address - Fax:
Practice Address - Street 1:2508 E RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78741-3099
Practice Address - Country:US
Practice Address - Phone:512-448-3353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX273958183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician