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General NPI Number Information
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NPI Number | 1700389996
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Entity Type | Individual
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Provider Name | DIANE SERVEDIO RPH
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Gender | Female
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Dates
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Enumeration Date | 03/14/2018
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Last Update Date | 11/18/2025
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Provider Practice Location Address
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Address Line | 1213 MAIN ST
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City | WILLIMANTIC
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State | CT
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Zip | 06226-1990
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Country | US
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Telephone | 860-423-1661
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Fax | 860-423-0301
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Provider Business Mailing Address
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Address Line | 1213 MAIN ST
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City | WILLIMANTIC
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State | CT
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Zip | 06226-1990
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Country | US
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Telephone | 860-423-1661
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Fax | 860-553-3384
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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 | 0006946
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License Number State | CT
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