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General NPI Number Information
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NPI Number | 1730230079
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Entity Type | Individual
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Provider Name | DIANE LYNN KONECHNE R.PH.
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Gender | Female
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Dates
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Enumeration Date | 01/15/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 818 W HAVENS ST
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City | MITCHELL
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State | SD
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Zip | 57301-3830
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Country | US
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Telephone | 605-996-5321
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Fax | 605-996-6090
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Provider Business Mailing Address
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Address Line | 1504 PEBBLE BEACH RD
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City | MITCHELL
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State | SD
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Zip | 57301-5015
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Country | US
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Telephone | 605-996-4438
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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 | 3718
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License Number State | SD
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