Provider Demographics
NPI:1265038129
Name:LAYTON, DIANE CAROL (RPH)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:CAROL
Last Name:LAYTON
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 1:209 GARDENDALE RD
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47803-1733
Mailing Address - Country:US
Mailing Address - Phone:812-240-5123
Mailing Address - Fax:
Practice Address - Street 1:307 E NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:BRAZIL
Practice Address - State:IN
Practice Address - Zip Code:47834-2629
Practice Address - Country:US
Practice Address - Phone:812-446-2301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26092030A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist