Provider Demographics
NPI:1134335383
Name:FARKAS, DIANE (RPH)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:
Last Name:FARKAS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4624 N 140 W
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE BRA
Mailing Address - State:IN
Mailing Address - Zip Code:47906-9748
Mailing Address - Country:US
Mailing Address - Phone:765-463-2858
Mailing Address - Fax:
Practice Address - Street 1:1415 SALEM ST
Practice Address - Street 2:SUITE B9
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-4100
Practice Address - Country:US
Practice Address - Phone:765-423-6358
Practice Address - Fax:765-423-6640
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26014506A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist