Healthcare Provider Details

I. General information

NPI: 1811101397
Provider Name (Legal Business Name): DANIELLE WEEDEN RAYMER PHARMD, CPP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 CHARLOIS BLVD
WINSTON SALEM NC
27103-1508
US

IV. Provider business mailing address

250 CHARLOIS BLVD
WINSTON SALEM NC
27103-1508
US

V. Phone/Fax

Practice location:
  • Phone: 336-718-1222
  • Fax: 336-718-1589
Mailing address:
  • Phone: 336-718-1222
  • Fax: 336-718-1589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number13565
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: