Provider Demographics
NPI:1912050808
Name:DASKIVICH, MARIE DIANE
Entity Type:Individual
Prefix:
First Name:MARIE DIANE
Middle Name:
Last Name:DASKIVICH
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 1:5180 FERGUSON RD
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-9480
Mailing Address - Country:US
Mailing Address - Phone:724-349-9092
Mailing Address - Fax:
Practice Address - Street 1:5180 FERGUSON RD
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-9480
Practice Address - Country:US
Practice Address - Phone:724-349-9092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP029811L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist