Provider Demographics
NPI:1285251744
Name:REINCKE, DIANA ELLEN (RPH)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:ELLEN
Last Name:REINCKE
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 1:9977 STOCKTON LN
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-2437
Mailing Address - Country:US
Mailing Address - Phone:224-578-3750
Mailing Address - Fax:
Practice Address - Street 1:250 N RANDALL RD
Practice Address - Street 2:
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-5943
Practice Address - Country:US
Practice Address - Phone:847-960-9910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051039454183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist