Provider Demographics
NPI:1154602613
Name:RAUM, DIANE
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:
Last Name:RAUM
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 1:13572 NW 9TH RD
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-8016
Mailing Address - Country:US
Mailing Address - Phone:352-505-3155
Mailing Address - Fax:
Practice Address - Street 1:13572 NW 9TH RD
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:FL
Practice Address - Zip Code:32669-8016
Practice Address - Country:US
Practice Address - Phone:352-505-3155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-29
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS39446183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist