Provider Demographics
NPI:1003876376
Name:HENRY, DIANE MICHELLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:MICHELLE
Last Name:HENRY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84-770 UPENA ST
Mailing Address - Street 2:
Mailing Address - City:WAIANAE
Mailing Address - State:HI
Mailing Address - Zip Code:96792-1936
Mailing Address - Country:US
Mailing Address - Phone:808-492-8258
Mailing Address - Fax:
Practice Address - Street 1:84-770 UPENA ST
Practice Address - Street 2:
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792-1936
Practice Address - Country:US
Practice Address - Phone:808-492-8258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57976183500000X
HIPH-3145183500000X
NE13581183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist