Provider Demographics
NPI:1649049685
Name:DIEM, EMMA WOODS
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:WOODS
Last Name:DIEM
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 1:10934 NATURE TRAIL DR APT 301
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-4222
Mailing Address - Country:US
Mailing Address - Phone:317-989-5031
Mailing Address - Fax:
Practice Address - Street 1:3620 PLAINFIELD RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46231-7014
Practice Address - Country:US
Practice Address - Phone:317-989-5031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-01
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26029778A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist