Provider Demographics
NPI:1366707036
Name:DANDRIDGE, DANIELA MARGARETHE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DANIELA
Middle Name:MARGARETHE
Last Name:DANDRIDGE
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:PO BOX 3360
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3360
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:931 S MARKET BLVD
Practice Address - Street 2:PMG SW WA CHEHALIS FAMILY MEDICINE
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-3423
Practice Address - Country:US
Practice Address - Phone:360-767-6300
Practice Address - Fax:360-767-6320
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 00016987183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist