Provider Demographics
NPI:1730473752
Name:PETROCELLI, DIANNE RENE (PHARMD)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:RENE
Last Name:PETROCELLI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 OFLANNERY CT
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25403-1318
Mailing Address - Country:US
Mailing Address - Phone:412-445-6549
Mailing Address - Fax:
Practice Address - Street 1:7916 WINCHESTER AVE
Practice Address - Street 2:
Practice Address - City:INWOOD
Practice Address - State:WV
Practice Address - Zip Code:25428-4066
Practice Address - Country:US
Practice Address - Phone:304-229-0935
Practice Address - Fax:304-229-5790
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0007321183500000X
MD19422183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist