Provider Demographics
NPI:1093995581
Name:CHARRON, DIANE LORI
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:LORI
Last Name:CHARRON
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 1:2115 DRIFTWOOD CIRCLE
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98363-8334
Mailing Address - Country:US
Mailing Address - Phone:360-670-6713
Mailing Address - Fax:
Practice Address - Street 1:621 S LINCOLN ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-6111
Practice Address - Country:US
Practice Address - Phone:360-452-2131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00049912183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist