Healthcare Provider Details

I. General information

NPI: 1528993508
Provider Name (Legal Business Name): DIANA THEUSCH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 44TH AVE
MOLINE IL
61265-6755
US

IV. Provider business mailing address

1257 E 46TH ST UNIT 201W
CHICAGO IL
60653-7500
US

V. Phone/Fax

Practice location:
  • Phone: 844-693-4889
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051303636
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: