Provider Demographics
NPI:1942802814
Name:WELSHANS, DIANE MARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:WELSHANS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:MARIE
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:509 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:IL
Mailing Address - Zip Code:61764-2017
Mailing Address - Country:US
Mailing Address - Phone:815-830-3277
Mailing Address - Fax:
Practice Address - Street 1:1706 W REYNOLDS ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:IL
Practice Address - Zip Code:61764-9695
Practice Address - Country:US
Practice Address - Phone:815-842-2230
Practice Address - Fax:815-844-5377
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-14
Last Update Date:2020-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051037142183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist