Provider Demographics
NPI:1548577380
Name:CARACCIOLA, DIANE (RPH)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:CARACCIOLA
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 1:2456 WILLARD RD
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-9127
Mailing Address - Country:US
Mailing Address - Phone:336-841-1545
Mailing Address - Fax:
Practice Address - Street 1:2456 WILLARD RD
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-9127
Practice Address - Country:US
Practice Address - Phone:336-841-1545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11994183500000X
FL18116183500000X
NY32164183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist