Healthcare Provider Details

I. General information

NPI: 1699982751
Provider Name (Legal Business Name): DIANNE C CARPENTER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 COSHOCTON AVE
MOUNT VERNON OH
43050-1975
US

IV. Provider business mailing address

313 CENTRAL STATION DR
JOHNSTOWN OH
43031-9493
US

V. Phone/Fax

Practice location:
  • Phone: 740-964-5105
  • Fax:
Mailing address:
  • Phone: 614-348-3641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03-3-26626
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: