Provider Demographics
NPI:1134402498
Name:RAD, DIANA C (RPH)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:C
Last Name:RAD
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 1:12260 SW 98TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-2530
Mailing Address - Country:US
Mailing Address - Phone:305-271-2185
Mailing Address - Fax:
Practice Address - Street 1:8300 PARK BLVD
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33126-3832
Practice Address - Country:US
Practice Address - Phone:305-269-7825
Practice Address - Fax:305-269-7834
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 22157183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist