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General NPI Number Information
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NPI Number | 1760789721
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Entity Type | Individual
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Provider Name | DIANA RISSELMANN RPH
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Gender | Female
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Dates
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Enumeration Date | 02/26/2011
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Last Update Date | 02/26/2011
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Provider Practice Location Address
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Address Line | 110 E MCKINLEY AVE
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City | MISHAWAKA
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State | IN
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Zip | 46545-6217
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Country | US
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Telephone | 574-255-9677
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Fax | 574-257-9772
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Provider Business Mailing Address
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Address Line | 52499 GLENMORE CT
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City | GRANGER
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State | IN
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Zip | 46530-7856
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Country | US
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Telephone | 574-277-9079
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Fax | 574-277-9079
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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 | 26015557A
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License Number State | IN
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