Healthcare Provider Details

I. General information

NPI: 1790898344
Provider Name (Legal Business Name): DIANE MARIE MCDERMOTT RPH.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 W MAIN ST
MARION IL
62959-1188
US

IV. Provider business mailing address

2401 W MAIN ST
MARION IL
62959-1188
US

V. Phone/Fax

Practice location:
  • Phone: 618-998-5804
  • Fax: 618-993-4188
Mailing address:
  • Phone: 618-998-5804
  • Fax: 618-993-4188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: