Provider Demographics
NPI:1376952580
Name:DIAMOND, LORI (PHARMD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:DIAMOND
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:DIAMOND
Other - Last Name:SINGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:512 VENTU PARK RD
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91320
Mailing Address - Country:US
Mailing Address - Phone:805-262-3413
Mailing Address - Fax:805-262-3407
Practice Address - Street 1:512 VENTU PARK RD
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91320
Practice Address - Country:US
Practice Address - Phone:805-262-3413
Practice Address - Fax:805-262-3407
Is Sole Proprietor?:No
Enumeration Date:2014-08-13
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35721183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA027613585OtherMEDICARE PROVIDER NUMBER
CA5650610OtherNCPPDP