Healthcare Provider Details

I. General information

NPI: 1326659525
Provider Name (Legal Business Name): DANIELLE NICOLE TIBBETT PHARM.D., M.A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2020
Last Update Date: 05/20/2023
Certification Date: 05/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 PLAZA WAY
WALLA WALLA WA
99362-4325
US

IV. Provider business mailing address

1600 PLAZA WAY
WALLA WALLA WA
99362-4325
US

V. Phone/Fax

Practice location:
  • Phone: 509-522-4672
  • Fax:
Mailing address:
  • Phone: 509-522-4672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP8912
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH61054380
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: