Provider Demographics
NPI:1447573720
Name:HERSHLINE, DIANE A (RPH)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:A
Last Name:HERSHLINE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 MENTOR AVE
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-6479
Mailing Address - Country:US
Mailing Address - Phone:440-974-7314
Mailing Address - Fax:440-205-8566
Practice Address - Street 1:9200 MENTOR AVE
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-6479
Practice Address - Country:US
Practice Address - Phone:440-974-7314
Practice Address - Fax:440-205-8566
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH13202183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist