Provider Demographics
NPI:1548576861
Name:CHAVEZ, DIANA LYNNE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:LYNNE
Last Name:CHAVEZ
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 1:2528 FALLBROOK WAY
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4296
Mailing Address - Country:US
Mailing Address - Phone:575-639-1869
Mailing Address - Fax:
Practice Address - Street 1:3100 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-1162
Practice Address - Country:US
Practice Address - Phone:575-525-0298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6124183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist