Provider Demographics
NPI:1700181120
Name:MCGUIRE, DIANA M (RPH)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:M
Last Name:MCGUIRE
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 1:11169 WATER TRACE DR
Mailing Address - Street 2:
Mailing Address - City:TEGA CAY
Mailing Address - State:SC
Mailing Address - Zip Code:29708-9375
Mailing Address - Country:US
Mailing Address - Phone:704-560-3638
Mailing Address - Fax:803-831-7512
Practice Address - Street 1:4724 CHARLOTTE HWY
Practice Address - Street 2:
Practice Address - City:LAKE WYLIE
Practice Address - State:SC
Practice Address - Zip Code:29710-8095
Practice Address - Country:US
Practice Address - Phone:803-831-1911
Practice Address - Fax:803-831-7512
Is Sole Proprietor?:No
Enumeration Date:2011-01-15
Last Update Date:2011-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9581183500000X
NC14191183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist