Provider Demographics
NPI:1649749243
Name:WUNDER, DANIELLE NICOLE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:NICOLE
Last Name:WUNDER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:NICOLE
Other - Last Name:KOCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2104 VAN REED RD
Mailing Address - Street 2:
Mailing Address - City:WEST LAWN
Mailing Address - State:PA
Mailing Address - Zip Code:19609-1163
Mailing Address - Country:US
Mailing Address - Phone:610-670-5426
Mailing Address - Fax:
Practice Address - Street 1:2104 VAN REED RD
Practice Address - Street 2:
Practice Address - City:WEST LAWN
Practice Address - State:PA
Practice Address - Zip Code:19609-1163
Practice Address - Country:US
Practice Address - Phone:610-670-5426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-13
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP450745183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist