Healthcare Provider Details

I. General information

NPI: 1790377505
Provider Name (Legal Business Name): DANICA GRACE LABORTE PUA RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2021
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 N MARINE CORPS DR
TAMUNING GU
96913-4109
US

IV. Provider business mailing address

PO BOX 26056
BARRIGADA GU
96921-6056
US

V. Phone/Fax

Practice location:
  • Phone: 671-649-7843
  • Fax: 671-649-7841
Mailing address:
  • Phone: 671-489-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH0356
License Number StateGU

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: