Provider Demographics
NPI:1184270126
Name:WHITE, DIANE (PHARMD)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 BEULAH CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:KY
Mailing Address - Zip Code:42347-9536
Mailing Address - Country:US
Mailing Address - Phone:217-415-8325
Mailing Address - Fax:
Practice Address - Street 1:102 W BROAD ST
Practice Address - Street 2:
Practice Address - City:CENTRAL CITY
Practice Address - State:KY
Practice Address - Zip Code:42330-1538
Practice Address - Country:US
Practice Address - Phone:270-754-1545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY020934183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist