MEDICARE: DIANE S FORDYCE RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	03313383	OH

General Provider Information

NPI Number	:	1336498807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE S FORDYCE RPH

Provider Business Mailing Address
First Line	:	2200 JUNE PKWY
Second Line	:
City	:	ZANESVILLE
State	:	OH
Zip	:	43701-6377
Country	:	US
Telephone Number	:	740-450-7859
Fax Number	:	740-450-7943

Provider Business Practice Location Address
First Line	:	2200 JUNE PKWY
Second Line	:
City	:	ZANESVILLE
State	:	OH
Zip	:	43701-6377
Country	:	US
Telephone Number	:	740-450-7859
Fax Number	:	740-450-7943

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2012
Last Update Date	:	08/30/2012

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Directions to “ DIANE S FORDYCE RPH” Practice Location

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