Provider Demographics
NPI:1942069075
Name:JOSEPH, DIANA (PHARMD)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:JOSEPH
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:PO BOX 542
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28082-0542
Mailing Address - Country:US
Mailing Address - Phone:941-587-5816
Mailing Address - Fax:
Practice Address - Street 1:2107 CONCORD LAKE RD
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-7416
Practice Address - Country:US
Practice Address - Phone:941-587-5816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX56202183500000X
FLPS41195183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist