Provider Demographics
NPI:1912685959
Name:MOOMAW, DANIELLE BREANN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:BREANN
Last Name:MOOMAW
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 1:40445 S GROESBECK HWY
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-5005
Mailing Address - Country:US
Mailing Address - Phone:586-239-7010
Mailing Address - Fax:586-239-7065
Practice Address - Street 1:40445 S GROESBECK HWY
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036-5005
Practice Address - Country:US
Practice Address - Phone:586-239-7010
Practice Address - Fax:586-239-7065
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302411876183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist