Provider Demographics
NPI:1689955817
Name:ADAMO, DIANE SUSAN (RPH)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:SUSAN
Last Name:ADAMO
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 1:903 E 13 MILE RD
Mailing Address - Street 2:
Mailing Address - City:DAFTER
Mailing Address - State:MI
Mailing Address - Zip Code:49724-9558
Mailing Address - Country:US
Mailing Address - Phone:906-635-0206
Mailing Address - Fax:
Practice Address - Street 1:2864 ASHMUN ST
Practice Address - Street 2:
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-3740
Practice Address - Country:US
Practice Address - Phone:906-632-5236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020224336183500000X
TX40776183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist