Provider Demographics
NPI:1841356961
Name:CASSATT, DIANE MARIE (RPH)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:MARIE
Last Name:CASSATT
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 1:4834 SCHAEFER CT
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-6914
Mailing Address - Country:US
Mailing Address - Phone:563-332-1247
Mailing Address - Fax:563-332-0804
Practice Address - Street 1:2900 DEVILS GLEN RD
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-3363
Practice Address - Country:US
Practice Address - Phone:563-332-2983
Practice Address - Fax:563-332-0804
Is Sole Proprietor?:No
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAC16889183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0123646Medicaid
IA0213410087Medicare ID - Type Unspecified