Provider Demographics
NPI:1639516552
Name:HACK, DIANNA M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DIANNA
Middle Name:M
Last Name:HACK
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 1:18 WHITTENS LN
Mailing Address - Street 2:
Mailing Address - City:HOLLIS CENTER
Mailing Address - State:ME
Mailing Address - Zip Code:04042-3943
Mailing Address - Country:US
Mailing Address - Phone:207-602-8489
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9422
Practice Address - Country:US
Practice Address - Phone:207-283-7875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-01
Last Update Date:2013-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR5308183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist