Provider Demographics
NPI:1609166693
Name:LINDENBERGER, DIANE KAY (RPH)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:KAY
Last Name:LINDENBERGER
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 1:2020 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-1554
Mailing Address - Country:US
Mailing Address - Phone:419-332-2186
Mailing Address - Fax:419-333-0472
Practice Address - Street 1:2020 W STATE ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-1554
Practice Address - Country:US
Practice Address - Phone:419-332-2186
Practice Address - Fax:419-333-0472
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03221197183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist