Provider Demographics
NPI:1003589250
Name:IKOME, DIANE ETONDE (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:ETONDE
Last Name:IKOME
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 BERMUDA LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40213-3332
Mailing Address - Country:US
Mailing Address - Phone:270-519-4985
Mailing Address - Fax:
Practice Address - Street 1:10445 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40272-3953
Practice Address - Country:US
Practice Address - Phone:502-935-3265
Practice Address - Fax:502-935-3423
Is Sole Proprietor?:No
Enumeration Date:2021-07-25
Last Update Date:2023-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY022162183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist