Provider Demographics
NPI:1609102144
Name:MORDINO, DANIELLE MARIE
Entity type:Individual
Prefix:MISS
First Name:DANIELLE
Middle Name:MARIE
Last Name:MORDINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19400 W CATAWBA AVE
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-4000
Mailing Address - Country:US
Mailing Address - Phone:704-893-9540
Mailing Address - Fax:704-892-7684
Practice Address - Street 1:19400 W CATAWBA AVE
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-4000
Practice Address - Country:US
Practice Address - Phone:704-893-9540
Practice Address - Fax:704-892-7684
Is Sole Proprietor?:No
Enumeration Date:2009-10-18
Last Update Date:2009-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15138183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist