Provider Demographics
NPI:1427365071
Name:FADNESS, DIANE E (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:E
Last Name:FADNESS
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 1:14840 SE WEBSTER RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97267-3249
Mailing Address - Country:US
Mailing Address - Phone:503-303-1090
Mailing Address - Fax:503-303-1075
Practice Address - Street 1:14840 SE WEBSTER RD
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97267-3249
Practice Address - Country:US
Practice Address - Phone:503-303-1090
Practice Address - Fax:503-303-1075
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0012286183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist