Provider Demographics
NPI:1801221247
Name:BANET, DIANE M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:M
Last Name:BANET
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 1:1300 S WATSON RD
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-6303
Mailing Address - Country:US
Mailing Address - Phone:623-691-6633
Mailing Address - Fax:
Practice Address - Street 1:1300 S WATSON RD
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-6303
Practice Address - Country:US
Practice Address - Phone:623-691-6633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19896183500000X
AZS021845183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist