Healthcare Provider Details

I. General information

NPI: 1336086537
Provider Name (Legal Business Name): GUINEVERE DIADEM OGBURN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2631 E DISCOVERY PKWY
BLOOMINGTON IN
47408-9059
US

IV. Provider business mailing address

243 MEADOWBROOK DR
SPRINGVILLE IN
47462-5464
US

V. Phone/Fax

Practice location:
  • Phone: 812-918-4320
  • Fax:
Mailing address:
  • Phone: 812-583-3117
  • Fax: 812-583-3117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number26025513A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: