Healthcare Provider Details

I. General information

NPI: 1255644985
Provider Name (Legal Business Name): DIANA MARIE MCKINNEY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2010
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 5TH AVE
MCKEESPORT PA
15132-2422
US

IV. Provider business mailing address

1500 5TH AVE
MCKEESPORT PA
15132-2422
US

V. Phone/Fax

Practice location:
  • Phone: 412-664-3100
  • Fax: 412-664-3101
Mailing address:
  • Phone: 412-664-3100
  • Fax: 412-664-3101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number21365
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP449019
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: