Provider Demographics
NPI:1609039866
Name:SPAGNUOLO, DIANE (RPH)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:SPAGNUOLO
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 1:2138 HEMLOCK FARMS
Mailing Address - Street 2:
Mailing Address - City:LORDS VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18428
Mailing Address - Country:US
Mailing Address - Phone:570-775-9109
Mailing Address - Fax:
Practice Address - Street 1:1 MAIN ST STE 6
Practice Address - Street 2:
Practice Address - City:DELHI
Practice Address - State:NY
Practice Address - Zip Code:13753-1106
Practice Address - Country:US
Practice Address - Phone:607-746-7110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2023-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0476981183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist