Provider Demographics
NPI:1811664097
Name:MAR, DANIELLE (PHARMD)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:MAR
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 1:2004 GOSSAMER AVE
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94065-2898
Mailing Address - Country:US
Mailing Address - Phone:650-218-6119
Mailing Address - Fax:
Practice Address - Street 1:9245 RESEDA BLVD
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-3137
Practice Address - Country:US
Practice Address - Phone:747-224-0373
Practice Address - Fax:818-727-7709
Is Sole Proprietor?:No
Enumeration Date:2021-08-25
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84835183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist