Provider Demographics
NPI:1043966989
Name:DANIELS, DEIDRE LYNN (PHARMD)
Entity type:Individual
Prefix:
First Name:DEIDRE
Middle Name:LYNN
Last Name:DANIELS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8700 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66109-1927
Mailing Address - Country:US
Mailing Address - Phone:870-514-6389
Mailing Address - Fax:
Practice Address - Street 1:8989 FOREST LN STE 138
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-4137
Practice Address - Country:US
Practice Address - Phone:469-839-3444
Practice Address - Fax:877-848-1331
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX496511835P0018X
MO20210462451835P0018X
KS1-147251835P0018X
ARPD111311835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist