Provider Demographics
NPI:1942446455
Name:SOMODY, DIANN
Entity Type:Individual
Prefix:
First Name:DIANN
Middle Name:
Last Name:SOMODY
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 1:1300 5TH ST SE
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-5321
Mailing Address - Country:US
Mailing Address - Phone:320-235-2506
Mailing Address - Fax:320-214-8673
Practice Address - Street 1:1300 5TH ST SE
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-5321
Practice Address - Country:US
Practice Address - Phone:320-235-2506
Practice Address - Fax:320-214-8673
Is Sole Proprietor?:No
Enumeration Date:2009-01-05
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN114946183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist