Provider Demographics
NPI:1922443043
Name:MCDIFFETT, DANA MICHELLE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:MICHELLE
Last Name:MCDIFFETT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:DANA
Other - Middle Name:MICHELLE
Other - Last Name:MCDIFFETT KELLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:10710 RESEARCH BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5780
Mailing Address - Country:US
Mailing Address - Phone:512-794-8227
Mailing Address - Fax:
Practice Address - Street 1:10710 RESEARCH BLVD STE 200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-5780
Practice Address - Country:US
Practice Address - Phone:512-794-8227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37642183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist