Provider Demographics
NPI:1184619868
Name:BOOMSMA, DIANE M (PHARM D)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:M
Last Name:BOOMSMA
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 E KING ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-2927
Mailing Address - Country:US
Mailing Address - Phone:717-397-4080
Mailing Address - Fax:
Practice Address - Street 1:201 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2705
Practice Address - Country:US
Practice Address - Phone:717-393-3814
Practice Address - Fax:717-393-7537
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP032236L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist