Provider Demographics
NPI:1669657615
Name:DIAMOND, ROCHELLE LEE (RPH)
Entity Type:Individual
Prefix:MS
First Name:ROCHELLE
Middle Name:LEE
Last Name:DIAMOND
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 1:8 THE TRL
Mailing Address - Street 2:
Mailing Address - City:HAMPTON BAYS
Mailing Address - State:NY
Mailing Address - Zip Code:11946-1935
Mailing Address - Country:US
Mailing Address - Phone:631-728-5925
Mailing Address - Fax:
Practice Address - Street 1:196 W MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:HAMPTON BAYS
Practice Address - State:NY
Practice Address - Zip Code:11946-2306
Practice Address - Country:US
Practice Address - Phone:631-728-2627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043503183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02680179Medicaid