Provider Demographics
NPI:1225317571
Name:ERDMAN, DIANE M (PHARMD, BCPS, CDE)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:ERDMAN
Suffix:
Gender:F
Credentials:PHARMD, BCPS, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 W CHAMBERS ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-1650
Mailing Address - Country:US
Mailing Address - Phone:414-447-2034
Mailing Address - Fax:414-874-4343
Practice Address - Street 1:5000 W CHAMBERS ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-1650
Practice Address - Country:US
Practice Address - Phone:414-447-2034
Practice Address - Fax:414-874-4343
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0197181835P0018X
WI17810-401835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist