Provider Demographics
NPI:1245370238
Name:VANAKEN, DIANNE LYNN (RPH)
Entity type:Individual
Prefix:MS
First Name:DIANNE
Middle Name:LYNN
Last Name:VANAKEN
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 1:603 RAEBURN RD
Mailing Address - Street 2:
Mailing Address - City:EATON RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:48827-1644
Mailing Address - Country:US
Mailing Address - Phone:517-663-6811
Mailing Address - Fax:517-663-6811
Practice Address - Street 1:122-124 S MAIN
Practice Address - Street 2:
Practice Address - City:EATON RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:48827
Practice Address - Country:US
Practice Address - Phone:517-663-6811
Practice Address - Fax:517-663-1732
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302025884183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist