Provider Demographics
NPI:1568758050
Name:DIAMOND DRUGS, INC.
Entity Type:Organization
Organization Name:DIAMOND DRUGS, INC.
Other - Org Name:DIAMOND PHARMACY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOUANN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-349-1111
Mailing Address - Street 1:645 KOLTER DR
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3570
Mailing Address - Country:US
Mailing Address - Phone:724-349-1111
Mailing Address - Fax:724-349-2984
Practice Address - Street 1:7 CHERRY ST
Practice Address - Street 2:
Practice Address - City:LEESPORT
Practice Address - State:PA
Practice Address - Zip Code:19533-8870
Practice Address - Country:US
Practice Address - Phone:888-441-0001
Practice Address - Fax:888-432-1481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-22
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4821053336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007302250010Medicaid