MEDICARE: DIANA DENISE DIZDAR RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	TX22831	TX

General Provider Information

NPI Number	:	1164763538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA DENISE DIZDAR RPH

Provider Business Mailing Address
First Line	:	15000 SAN PEDRO AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-3714
Country	:	US
Telephone Number	:	210-494-3203
Fax Number	:	210-545-6425

Provider Business Practice Location Address
First Line	:	15000 SAN PEDRO AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-3714
Country	:	US
Telephone Number	:	210-494-3203
Fax Number	:	210-545-6425

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2013
Last Update Date	:	03/11/2013

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Directions to “ DIANA DENISE DIZDAR RPH” Practice Location

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