Provider Demographics
NPI:1396349908
Name:NELSON, DAINA CAMILLE (PHARM,D)
Entity type:Individual
Prefix:DR
First Name:DAINA
Middle Name:CAMILLE
Last Name:NELSON
Suffix:
Gender:F
Credentials:PHARM,D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6150 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-2538
Mailing Address - Country:US
Mailing Address - Phone:773-274-9337
Mailing Address - Fax:773-274-9316
Practice Address - Street 1:6150 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-2538
Practice Address - Country:US
Practice Address - Phone:773-274-9337
Practice Address - Fax:773-274-9316
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051286361183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist