Provider Demographics
NPI:1295103042
Name:DIAZ, DANIELLA MARISSA (RPH)
Entity type:Individual
Prefix:
First Name:DANIELLA
Middle Name:MARISSA
Last Name:DIAZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 SANDOWN RD
Mailing Address - Street 2:
Mailing Address - City:EAST HAMPSTEAD
Mailing Address - State:NH
Mailing Address - Zip Code:03826-2408
Mailing Address - Country:US
Mailing Address - Phone:603-329-0187
Mailing Address - Fax:
Practice Address - Street 1:305 SANDOWN RD
Practice Address - Street 2:
Practice Address - City:EAST HAMPSTEAD
Practice Address - State:NH
Practice Address - Zip Code:03826-2408
Practice Address - Country:US
Practice Address - Phone:603-329-0187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-10
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH4193183500000X
MAPH236269183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist