Provider Demographics
NPI:1801489844
Name:GALLUPE, DANIELLE LILLIAN
Entity type:Individual
Prefix:MISS
First Name:DANIELLE
Middle Name:LILLIAN
Last Name:GALLUPE
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 1:19926 BROWNSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21758-1009
Mailing Address - Country:US
Mailing Address - Phone:240-818-4615
Mailing Address - Fax:
Practice Address - Street 1:19926 BROWNSVILLE RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:MD
Practice Address - Zip Code:21758-1009
Practice Address - Country:US
Practice Address - Phone:240-818-4615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDPI01623183500000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty