Provider Demographics
NPI:1992086854
Name:ORTEGON, DANIELLE LYNN (PHARM D)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:LYNN
Last Name:ORTEGON
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 1:7 HOLLY LN
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-4723
Mailing Address - Country:US
Mailing Address - Phone:203-793-7620
Mailing Address - Fax:
Practice Address - Street 1:25 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-3203
Practice Address - Country:US
Practice Address - Phone:203-859-3695
Practice Address - Fax:203-859-3695
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0011055183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist