=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952734998
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DIANE P RICHARD RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2013
-----------------------------------------------------
Last Update Date | 08/13/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8001 LINCOLN AVE SUITE 800
-----------------------------------------------------
City | SKOKIE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60077-3695
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-457-1168
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8001 LINCOLN AVE SUITE 800
-----------------------------------------------------
City | SKOKIE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60077-3695
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-457-1168
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PCT.0004811
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------