Provider Demographics
NPI:1285940650
Name:GUSEV, DIANA (PHARM D)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:
Last Name:GUSEV
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 ROSS CT
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-7894
Mailing Address - Country:US
Mailing Address - Phone:609-597-8251
Mailing Address - Fax:
Practice Address - Street 1:592 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BARNEGAT
Practice Address - State:NJ
Practice Address - Zip Code:08005
Practice Address - Country:US
Practice Address - Phone:609-698-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02956500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist