Provider Demographics
NPI:1285989970
Name:D'ALFONSO, DANIELLE (PHARMD)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:D'ALFONSO
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 1:365 ALLEN AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-3728
Mailing Address - Country:US
Mailing Address - Phone:207-797-4351
Mailing Address - Fax:207-878-3135
Practice Address - Street 1:365 ALLEN AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-3728
Practice Address - Country:US
Practice Address - Phone:207-797-4351
Practice Address - Fax:207-878-3135
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR12455183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist