MEDICARE: DIANA LYNN MARICHAL

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	183700000X	Pharmacy Technician	198336	TX

General Provider Information

NPI Number	:	1861037426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA LYNN MARICHAL

Provider Business Mailing Address
First Line	:	PO BOX 14024
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76094-1024
Country	:	US
Telephone Number	:	904-673-6242
Fax Number	:

Provider Business Practice Location Address
First Line	:	2730 EDMONDS LN STE 400
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75067-6731
Country	:	US
Telephone Number	:	877-369-6083
Fax Number	:

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

Provider Enumeration Date	:	11/07/2019
Last Update Date	:	11/07/2019

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Directions to “ DIANA LYNN MARICHAL ” Practice Location

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