Healthcare Provider Details

I. General information

NPI: 1386254993
Provider Name (Legal Business Name): DANIELLE TAKALA RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2020
Last Update Date: 08/07/2020
Certification Date: 08/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15445 W NATIONAL AVE
NEW BERLIN WI
53151-5156
US

IV. Provider business mailing address

15445 W NATIONAL AVE
NEW BERLIN WI
53151-5156
US

V. Phone/Fax

Practice location:
  • Phone: 262-938-0133
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number20426
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: