Provider Demographics
NPI:1710100961
Name:DUFF, DYAN SUE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DYAN
Middle Name:SUE
Last Name:DUFF
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 1:220 HEMLOCK DR
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-2328
Mailing Address - Country:US
Mailing Address - Phone:770-364-5911
Mailing Address - Fax:404-508-7733
Practice Address - Street 1:445 WINN WAY STE 220
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1707
Practice Address - Country:US
Practice Address - Phone:404-508-7738
Practice Address - Fax:404-508-7733
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12634183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist