Provider Demographics
NPI:1942586342
Name:DIALLO, KHADIDIATOU (PHARMD)
Entity Type:Individual
Prefix:
First Name:KHADIDIATOU
Middle Name:
Last Name:DIALLO
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 1:31 CAVALRY DR
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-5201
Mailing Address - Country:US
Mailing Address - Phone:845-634-3341
Mailing Address - Fax:
Practice Address - Street 1:31 CAVALRY DR
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-5201
Practice Address - Country:US
Practice Address - Phone:845-634-3341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-29
Last Update Date:2011-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055575183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist