Provider Demographics
NPI:1043660368
Name:MECHELAY, DIANA RENEE (PHARMD)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:RENEE
Last Name:MECHELAY
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 1:1120 W SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:BREMEN
Mailing Address - State:IN
Mailing Address - Zip Code:46506-1849
Mailing Address - Country:US
Mailing Address - Phone:574-335-7800
Mailing Address - Fax:
Practice Address - Street 1:1120 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:BREMEN
Practice Address - State:IN
Practice Address - Zip Code:46506-1849
Practice Address - Country:US
Practice Address - Phone:574-335-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-17
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26026606A1835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN26026606AOtherPHARMACIST LICENSE