Provider Demographics
NPI:1285954081
Name:ROY, DIANE MCCRARY
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:MCCRARY
Last Name:ROY
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 1:760 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124-3156
Mailing Address - Country:US
Mailing Address - Phone:504-483-2383
Mailing Address - Fax:504-483-8165
Practice Address - Street 1:760 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70124-3156
Practice Address - Country:US
Practice Address - Phone:504-483-2383
Practice Address - Fax:504-483-8165
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9268183500000X
MI5302034426183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist