Provider Demographics
NPI:1508139858
Name:KOHMESCHER, DIANE LYNN (PHARMD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:LYNN
Last Name:KOHMESCHER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:LYNN
Other - Last Name:DOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2215 FULLER RD
Mailing Address - Street 2:VA MEDICAL CENTER
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-2303
Mailing Address - Country:US
Mailing Address - Phone:734-845-3032
Mailing Address - Fax:
Practice Address - Street 1:2215 FULLER RD
Practice Address - Street 2:VA MEDICAL CENTER
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-2303
Practice Address - Country:US
Practice Address - Phone:734-845-3032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020341561835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy