Provider Demographics
NPI:1780844464
Name:HANCOCK, DIANE LEE MICHELLE (CPHT)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:LEE MICHELLE
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 14TH ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421-3636
Mailing Address - Country:US
Mailing Address - Phone:812-275-0301
Mailing Address - Fax:
Practice Address - Street 1:1320 JAMES AVE
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-3592
Practice Address - Country:US
Practice Address - Phone:812-275-0301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN670004283A183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician