Provider Demographics
NPI:1386909182
Name:YAMAMOTO, DIANE WONG (PHARMD)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:WONG
Last Name:YAMAMOTO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:WONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:740 NE 3RD ST, STE 3 PMB 120
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4700
Mailing Address - Country:US
Mailing Address - Phone:818-237-0038
Mailing Address - Fax:541-317-3404
Practice Address - Street 1:740 NE 3RD ST, STE 3 PMB 120
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4700
Practice Address - Country:US
Practice Address - Phone:818-237-0038
Practice Address - Fax:541-317-3404
Is Sole Proprietor?:No
Enumeration Date:2012-07-08
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH39920183500000X
NV09119183500000X
ORRPH10390183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist