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General NPI Number Information
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NPI Number | 1861296402
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Entity Type | Individual
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Provider Name | DIANA HADDAD PHARMACIST
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Gender | Female
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Dates
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Enumeration Date | 04/02/2025
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Last Update Date | 04/02/2025
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Provider Practice Location Address
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Address Line | 27177 STATE HIGHWAY 189
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City | BLUE JAY
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State | CA
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Zip | 92317-0017
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Country | US
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Telephone | 909-336-1275
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Fax |
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Provider Business Mailing Address
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Address Line | 47089 WOODBERRY ESTATES DR
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City | MACOMB
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State | MI
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Zip | 48044-3033
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Country | US
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Telephone | 586-623-1013
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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 | 90714
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 5302415820
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License Number State | MI
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