Provider Demographics
NPI:1134405921
Name:LAVIERY, DIANA (PS32338)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:LAVIERY
Suffix:
Gender:F
Credentials:PS32338
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2417 NW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8783
Mailing Address - Country:US
Mailing Address - Phone:561-676-7064
Mailing Address - Fax:
Practice Address - Street 1:3320 SE SALERNO RD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-6719
Practice Address - Country:US
Practice Address - Phone:772-283-1714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS32338183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist