Provider Demographics
NPI:1083934715
Name:KOVNAT, DIANA LEA (RPH)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:LEA
Last Name:KOVNAT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33330 W 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3311
Mailing Address - Country:US
Mailing Address - Phone:248-553-4050
Mailing Address - Fax:248-553-3242
Practice Address - Street 1:33330 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3311
Practice Address - Country:US
Practice Address - Phone:248-553-4050
Practice Address - Fax:248-553-3242
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-04
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302023185183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist