Provider Demographics
NPI:1588866123
Name:SMYSER, DANIELLE N (RPH)
Entity type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:N
Last Name:SMYSER
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 1:11 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:IL
Mailing Address - Zip Code:61242-9711
Mailing Address - Country:US
Mailing Address - Phone:660-216-0595
Mailing Address - Fax:
Practice Address - Street 1:2002 SPRUCE HILLS DR
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-2627
Practice Address - Country:US
Practice Address - Phone:660-947-2411
Practice Address - Fax:660-947-3825
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO045226183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO356215103Medicaid