Provider Demographics
NPI:1982242830
Name:USANA, DIANNE KATRINA GUMAHAD (RPH)
Entity Type:Individual
Prefix:
First Name:DIANNE KATRINA
Middle Name:GUMAHAD
Last Name:USANA
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 1:1391 BISON LN
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60192-4554
Mailing Address - Country:US
Mailing Address - Phone:224-634-8580
Mailing Address - Fax:
Practice Address - Street 1:1391 BISON LN
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60192-4554
Practice Address - Country:US
Practice Address - Phone:224-634-8580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051302555183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty