Provider Demographics
NPI:1932225026
Name:DANIELS, PAIGE RENE' (RPH)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:RENE'
Last Name:DANIELS
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 1:410 CAMBRIDGE LN.
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60404
Mailing Address - Country:US
Mailing Address - Phone:815-744-5969
Mailing Address - Fax:
Practice Address - Street 1:435 N WEBER RD
Practice Address - Street 2:
Practice Address - City:ROMEOVILLE
Practice Address - State:IL
Practice Address - Zip Code:60446-3972
Practice Address - Country:US
Practice Address - Phone:815-293-3309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051037951183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist