MEDICARE: DANIELLE ASHLEY WALDRON PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	063668	NY

General Provider Information

NPI Number	:	1396258349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE ASHLEY WALDRON PHARM.D.

Provider Business Mailing Address
First Line	:	12 SUSSEX ST
Second Line	:
City	:	PORT JERVIS
State	:	NY
Zip	:	12771-2421
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12 SUSSEX ST
Second Line	:
City	:	PORT JERVIS
State	:	NY
Zip	:	12771-2421
Country	:	US
Telephone Number	:	845-856-8314
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2017
Last Update Date	:	11/13/2017

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