Provider Demographics
NPI:1114236767
Name:CREEKMORE, DIANE PARKER (RPH)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:PARKER
Last Name:CREEKMORE
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 1:3914 CAPITAL BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-3412
Mailing Address - Country:US
Mailing Address - Phone:919-876-5600
Mailing Address - Fax:919-876-2475
Practice Address - Street 1:3914 CAPITAL BOULEVARD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-3412
Practice Address - Country:US
Practice Address - Phone:919-876-5600
Practice Address - Fax:919-876-2475
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC09729183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist