Provider Demographics
NPI:1275909913
Name:NELSON, DANIELLE (PHARMD)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:NELSON
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 1:4111 N DRINKWATER BLVD
Mailing Address - Street 2:APT A408
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-3647
Mailing Address - Country:US
Mailing Address - Phone:928-814-9887
Mailing Address - Fax:
Practice Address - Street 1:9830 W LOWER BUCKEYE RD
Practice Address - Street 2:
Practice Address - City:TOLLESON
Practice Address - State:AZ
Practice Address - Zip Code:85353-1401
Practice Address - Country:US
Practice Address - Phone:623-687-2137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS021493183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist