Provider Demographics
NPI:1124174818
Name:FITZSIMMONS, DIANJE TURNER (RPH)
Entity type:Individual
Prefix:MS
First Name:DIANJE
Middle Name:TURNER
Last Name:FITZSIMMONS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:DIANE
Other - Middle Name:TURNER
Other - Last Name:CROUCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:109 RUSTIC HIGHLANDS
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-9263
Mailing Address - Country:US
Mailing Address - Phone:304-757-3285
Mailing Address - Fax:304-757-3285
Practice Address - Street 1:1 SUGAR MAPLE LN
Practice Address - Street 2:CHD MERIDIAN CENTER
Practice Address - City:BUFFALO
Practice Address - State:WV
Practice Address - Zip Code:25033-9430
Practice Address - Country:US
Practice Address - Phone:304-937-7429
Practice Address - Fax:304-937-7431
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3318183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist