Provider Demographics
NPI:1508887886
Name:HARMS, DIANNE (RPH)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:
Last Name:HARMS
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 1:75475 ROAD 344
Mailing Address - Street 2:
Mailing Address - City:ELSIE
Mailing Address - State:NE
Mailing Address - Zip Code:69134-4048
Mailing Address - Country:US
Mailing Address - Phone:308-228-2392
Mailing Address - Fax:
Practice Address - Street 1:1324 BROADWAY
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:NE
Practice Address - Zip Code:69033-0597
Practice Address - Country:US
Practice Address - Phone:308-882-4863
Practice Address - Fax:308-882-4510
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11588183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025337400Medicaid
NE10025337400Medicaid