Provider Demographics
NPI:1033540752
Name:MARCHUT, DIANE
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:MARCHUT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 ROUTE 34
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-7132
Mailing Address - Country:US
Mailing Address - Phone:630-554-5616
Mailing Address - Fax:630-554-5745
Practice Address - Street 1:2300 ROUTE 34
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-7132
Practice Address - Country:US
Practice Address - Phone:630-554-5616
Practice Address - Fax:630-554-5745
Is Sole Proprietor?:No
Enumeration Date:2013-12-05
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051041247183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist