Provider Demographics
NPI:1457618266
Name:NELSON, DANIELLE B (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:B
Last Name:NELSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8415 TARNWOOD PATH
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-4532
Mailing Address - Country:US
Mailing Address - Phone:719-761-7826
Mailing Address - Fax:
Practice Address - Street 1:3570 HARTSEL DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-4165
Practice Address - Country:US
Practice Address - Phone:719-590-7515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-18
Last Update Date:2020-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17253183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist