Provider Demographics
NPI:1710278460
Name:KURISCAK, DIANE FOURNIER (RPH)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:FOURNIER
Last Name:KURISCAK
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 ALEXANDRA DR
Mailing Address - Street 2:
Mailing Address - City:ASSONET
Mailing Address - State:MA
Mailing Address - Zip Code:02702-1722
Mailing Address - Country:US
Mailing Address - Phone:508-644-5205
Mailing Address - Fax:
Practice Address - Street 1:323 WILLIAM S CANNING BLVD
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-2339
Practice Address - Country:US
Practice Address - Phone:508-678-0080
Practice Address - Fax:508-678-0163
Is Sole Proprietor?:No
Enumeration Date:2011-04-28
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23632183500000X
RI3965183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist