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General NPI Number Information
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NPI Number | 1275902256
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Entity Type | Individual
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Provider Name | DIANA PAVLOVNA REZNIKOV PHARM.D.
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Gender | Female
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Dates
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Enumeration Date | 09/18/2015
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Last Update Date | 09/18/2015
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Provider Practice Location Address
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Address Line | 1165 MONTGOMERY DR
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City | SANTA ROSA
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State | CA
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Zip | 95405-4801
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Country | US
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Telephone | 707-525-5380
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Fax |
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Provider Business Mailing Address
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Address Line | 2105 LONGHORN CIR
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City | SANTA ROSA
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State | CA
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Zip | 95401-6750
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Country | US
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Telephone | 707-477-6996
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 73119
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License Number State | CA
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