Healthcare Provider Details

I. General information

NPI: 1477225852
Provider Name (Legal Business Name): DANIELLE DAGUINOD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2021
Last Update Date: 10/04/2021
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1932 REES ST
BREAUX BRIDGE LA
70517-4212
US

IV. Provider business mailing address

1932 REES ST
BREAUX BRIDGE LA
70517-4212
US

V. Phone/Fax

Practice location:
  • Phone: 337-332-1100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPST.024082
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: