MEDICARE: DIANE MARY FORD R.P.

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	RP036546L	PA

General Provider Information

NPI Number	:	1922128420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE MARY FORD R.P.

Provider Business Mailing Address
First Line	:	304 EISENHOWER DR
Second Line	:
City	:	NATRONA HEIGHTS
State	:	PA
Zip	:	15065-2508
Country	:	US
Telephone Number	:	724-224-6211
Fax Number	:

Provider Business Practice Location Address
First Line	:	412 E 4TH AVE
Second Line	:
City	:	TARENTUM
State	:	PA
Zip	:	15084-1810
Country	:	US
Telephone Number	:	724-224-3334
Fax Number	:

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

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	07/08/2007

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