Provider Demographics
NPI:1720393788
Name:MORRILL, DIANE R (RPH)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:R
Last Name:MORRILL
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 1:708 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4328
Mailing Address - Country:US
Mailing Address - Phone:701-746-0497
Mailing Address - Fax:701-746-7908
Practice Address - Street 1:708 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4328
Practice Address - Country:US
Practice Address - Phone:701-746-0497
Practice Address - Fax:701-746-7908
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-15
Last Update Date:2010-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3803183500000X
MN112952183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist