Provider Demographics
NPI:1386925667
Name:SWEENEY, DIANE SOPHIE
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:SOPHIE
Last Name:SWEENEY
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 1:175 QUEEN CITY AVE
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-7121
Mailing Address - Country:US
Mailing Address - Phone:603-663-5678
Mailing Address - Fax:603-663-3202
Practice Address - Street 1:175 QUEEN CITY AVE
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-7121
Practice Address - Country:US
Practice Address - Phone:603-663-5678
Practice Address - Fax:603-663-3202
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHR1929183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist