Provider Demographics
NPI:1629364179
Name:HARROD, DIANE MARIE (PHARMACIST)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:MARIE
Last Name:HARROD
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4370 VENTURE DR
Mailing Address - Street 2:T0929
Mailing Address - City:PERU
Mailing Address - State:IL
Mailing Address - Zip Code:61354-1013
Mailing Address - Country:US
Mailing Address - Phone:815-224-2408
Mailing Address - Fax:815-224-2408
Practice Address - Street 1:4370 VENTURE DR
Practice Address - Street 2:T0929
Practice Address - City:PERU
Practice Address - State:IL
Practice Address - Zip Code:61354-1013
Practice Address - Country:US
Practice Address - Phone:815-224-2408
Practice Address - Fax:815-224-2408
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051032072183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist