Provider Demographics
NPI:1801371869
Name:KACHMAREK, DIANNA LEE
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:LEE
Last Name:KACHMAREK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 IVY LN
Mailing Address - Street 2:
Mailing Address - City:PARSONS
Mailing Address - State:WV
Mailing Address - Zip Code:26287-1337
Mailing Address - Country:US
Mailing Address - Phone:304-478-2319
Mailing Address - Fax:304-478-2532
Practice Address - Street 1:149 IVY LN
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:WV
Practice Address - Zip Code:26287-1337
Practice Address - Country:US
Practice Address - Phone:304-478-2319
Practice Address - Fax:304-478-2532
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0006736183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist