Provider Demographics
NPI:1720306731
Name:DESLAURIERS, DIANE MICHELLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:MICHELLE
Last Name:DESLAURIERS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 UNIVERSITY AVE SE
Mailing Address - Street 2:UNIT 512
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-1163
Mailing Address - Country:US
Mailing Address - Phone:612-518-6019
Mailing Address - Fax:
Practice Address - Street 1:45 UNIVERSITY AVE SE
Practice Address - Street 2:UNIT 512
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-1000
Practice Address - Country:US
Practice Address - Phone:612-518-6019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-14
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN808122183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist