Provider Demographics
NPI:1598102618
Name:FORD, DIANE ELIZABETH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:ELIZABETH
Last Name:FORD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 RIVERSTONE PKWY
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-5624
Mailing Address - Country:US
Mailing Address - Phone:770-720-1042
Mailing Address - Fax:770-479-9193
Practice Address - Street 1:1451 RIVERSTONE PKWY
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-5624
Practice Address - Country:US
Practice Address - Phone:770-720-1042
Practice Address - Fax:770-479-9193
Is Sole Proprietor?:No
Enumeration Date:2013-05-30
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH024842183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist