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General NPI Number Information
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NPI Number | 1861037426
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Entity Type | Individual
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Provider Name | DIANA LYNN MARICHAL
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Gender | Female
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Dates
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Enumeration Date | 11/07/2019
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Last Update Date | 11/07/2019
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Provider Practice Location Address
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Address Line | 2730 EDMONDS LN STE 400
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City | LEWISVILLE
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State | TX
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Zip | 75067-6731
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Country | US
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Telephone | 877-369-6083
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 14024
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City | ARLINGTON
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State | TX
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Zip | 76094-1024
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Country | US
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Telephone | 904-673-6242
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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 | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 198336
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License Number State | TX
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