Provider Demographics
NPI:1194597518
Name:SECUNDINO, DAISY JOALY (PHARMACIST)
Entity type:Individual
Prefix:
First Name:DAISY
Middle Name:JOALY
Last Name:SECUNDINO
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 N GALLOWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-4327
Mailing Address - Country:US
Mailing Address - Phone:214-815-8110
Mailing Address - Fax:
Practice Address - Street 1:401 N GALLOWAY AVE
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-4327
Practice Address - Country:US
Practice Address - Phone:214-815-8110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73147183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist