Provider Demographics
NPI:1740810217
Name:BRICE, DIANE LAURA (PHARMD)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:LAURA
Last Name:BRICE
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 1:752 CHARNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-1085
Mailing Address - Country:US
Mailing Address - Phone:973-650-1699
Mailing Address - Fax:
Practice Address - Street 1:752 CHARNWOOD DR
Practice Address - Street 2:
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-1085
Practice Address - Country:US
Practice Address - Phone:973-650-1699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03011500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist