Provider Demographics
NPI:1063016798
Name:PALLARIA, DIANA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:PALLARIA
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 1:76 SWAN ST
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-5021
Mailing Address - Country:US
Mailing Address - Phone:978-688-9002
Mailing Address - Fax:
Practice Address - Street 1:76 SWAN ST
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-5021
Practice Address - Country:US
Practice Address - Phone:978-688-9002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH01053183500000X
MA234590183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist