Provider Demographics
NPI:1215021969
Name:ROESSNER, DIANE RENEE (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:RENEE
Last Name:ROESSNER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 SCHROEDER RD
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:OH
Mailing Address - Zip Code:45822-9734
Mailing Address - Country:US
Mailing Address - Phone:419-942-0780
Mailing Address - Fax:
Practice Address - Street 1:366 W DEERFIELD RD
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:IN
Practice Address - Zip Code:47390-1039
Practice Address - Country:US
Practice Address - Phone:765-964-3098
Practice Address - Fax:765-964-3093
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26021915A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist