Provider Demographics
NPI:1518431055
Name:DIFFEY, VIRGINIA DAYLE (RPH)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:DAYLE
Last Name:DIFFEY
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 1:102 COURT SQ
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MS
Mailing Address - Zip Code:39095-3626
Mailing Address - Country:US
Mailing Address - Phone:662-834-2722
Mailing Address - Fax:662-834-1711
Practice Address - Street 1:102 COURT SQ
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MS
Practice Address - Zip Code:39095-3626
Practice Address - Country:US
Practice Address - Phone:662-834-2722
Practice Address - Fax:662-834-1711
Is Sole Proprietor?:No
Enumeration Date:2019-01-17
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE8638183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist