Healthcare Provider Details

I. General information

NPI: 1649749243
Provider Name (Legal Business Name): DANIELLE NICOLE WUNDER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DANIELLE NICOLE KOCH PHARMD

II. Dates (important events)

Enumeration Date: 11/13/2018
Last Update Date: 02/09/2023
Certification Date: 02/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2104 VAN REED RD
WEST LAWN PA
19609-1163
US

IV. Provider business mailing address

2104 VAN REED RD
WEST LAWN PA
19609-1163
US

V. Phone/Fax

Practice location:
  • Phone: 610-670-5426
  • Fax:
Mailing address:
  • Phone: 610-670-5426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP450745
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: