Provider Demographics
NPI:1750697488
Name:FASANELLA, DANA RENE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:RENE
Last Name:FASANELLA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BACKBONE RD
Mailing Address - Street 2:SOMERSET HALL - UMES SCHOOL OF PHARMACY
Mailing Address - City:PRINCESS ANNE
Mailing Address - State:MD
Mailing Address - Zip Code:21853
Mailing Address - Country:US
Mailing Address - Phone:410-621-2292
Mailing Address - Fax:
Practice Address - Street 1:1665 WOODBROOKE DR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-8502
Practice Address - Country:US
Practice Address - Phone:410-546-6650
Practice Address - Fax:410-546-2656
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX48952183500000X
NC21079183500000X
MD209071835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist