Provider Demographics
NPI:1568738045
Name:STRAUCHON, DIANE E (CPHT)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:E
Last Name:STRAUCHON
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2153 HAW CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:EMMETT
Mailing Address - State:ID
Mailing Address - Zip Code:83617-9680
Mailing Address - Country:US
Mailing Address - Phone:208-365-5741
Mailing Address - Fax:
Practice Address - Street 1:179 W HIGHWAY 52
Practice Address - Street 2:
Practice Address - City:EMMETT
Practice Address - State:ID
Practice Address - Zip Code:83617-9738
Practice Address - Country:US
Practice Address - Phone:208-272-9454
Practice Address - Fax:208-272-9460
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCT-1055183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician