Provider Demographics
NPI:1114403763
Name:LISCHIN, DIANA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:
Last Name:LISCHIN
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:PO BOX 811
Mailing Address - Street 2:
Mailing Address - City:COATS
Mailing Address - State:NC
Mailing Address - Zip Code:27521-0811
Mailing Address - Country:US
Mailing Address - Phone:910-897-8500
Mailing Address - Fax:910-897-5114
Practice Address - Street 1:50 E DEPOT ST
Practice Address - Street 2:
Practice Address - City:ANGIER
Practice Address - State:NC
Practice Address - Zip Code:27501-6017
Practice Address - Country:US
Practice Address - Phone:919-422-5936
Practice Address - Fax:910-897-5114
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9446183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist