Provider Demographics
NPI:1346894011
Name:DIEKVOSS, LINDSAY M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LINDSAY
Middle Name:M
Last Name:DIEKVOSS
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 1:12501 STONE VILLAGE WAY
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-2715
Mailing Address - Country:US
Mailing Address - Phone:804-419-9945
Mailing Address - Fax:
Practice Address - Street 1:650 HYLAN DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-4297
Practice Address - Country:US
Practice Address - Phone:585-424-7350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-30
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202214508183500000X
NY061436183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist