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General NPI Number Information
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NPI Number | 1922147834
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Entity Type | Individual
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Provider Name | DANIELLE LOREN DEDMON P.D.
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Gender | Female
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 02/05/2024
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Provider Practice Location Address
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Address Line | 6210 MASSARD RD STE 104
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City | FORT SMITH
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State | AR
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Zip | 72916-5042
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Country | US
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Telephone | 479-551-2840
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Fax | 918-962-5750
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Provider Business Mailing Address
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Address Line | 6210 MASSARD RD STE 104
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City | FORT SMITH
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State | AR
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Zip | 72916-5042
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Country | US
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Telephone | 479-551-2840
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Fax | 479-551-2492
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PD08844
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License Number State | AR
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