Provider Demographics
NPI:1891759742
Name:BROGCINSKI, DIADRA ELAINE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DIADRA
Middle Name:ELAINE
Last Name:BROGCINSKI
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 1:5 KING FISHER DR
Mailing Address - Street 2:
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559-2256
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:851 FAIRPORT RD
Practice Address - Street 2:
Practice Address - City:EAST ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14445-1909
Practice Address - Country:US
Practice Address - Phone:585-586-7922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-15
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043706183500000X
VT0003579183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist