Provider Demographics
NPI:1134718927
Name:CLOUSER, DIANA KAY
Entity type:Individual
Prefix:MISS
First Name:DIANA
Middle Name:KAY
Last Name:CLOUSER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16089 TENOR WAY
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-9297
Mailing Address - Country:US
Mailing Address - Phone:317-696-2722
Mailing Address - Fax:
Practice Address - Street 1:100 N ANDERSON ST
Practice Address - Street 2:
Practice Address - City:ELWOOD
Practice Address - State:IN
Practice Address - Zip Code:46036-1541
Practice Address - Country:US
Practice Address - Phone:765-552-9565
Practice Address - Fax:765-552-1289
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26018223A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist