Provider Demographics
NPI:1679981054
Name:ENDERS-JACK, DANIELLE ELIZABETH (PHARMD, RPH)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:ELIZABETH
Last Name:ENDERS-JACK
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 BLUFF ST
Mailing Address - Street 2:
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-2173
Mailing Address - Country:US
Mailing Address - Phone:724-664-3010
Mailing Address - Fax:
Practice Address - Street 1:105 GAMMA DR
Practice Address - Street 2:SUITE 100
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-2963
Practice Address - Country:US
Practice Address - Phone:412-449-0680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP446647183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist