Individual
DANIELLE KANALLAKAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
705 S STATE ST, JERSEYVILLE, IL 62052-2340
(618) 498-4989
Mailing address
802 WEST CARPENTER, JERSEYVILLE, IL 62052
(618) 639-8188
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
051-286207
IL
Other
Enumeration date
10/05/2011
Last updated
10/05/2011
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