Provider Demographics
NPI:1427274588
Name:GAHAN, DIANE MARIE (RPH)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:GAHAN
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 1:315 SW 5TH AVE # 900
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-1703
Mailing Address - Country:US
Mailing Address - Phone:503-416-5963
Mailing Address - Fax:
Practice Address - Street 1:315 SW 5TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-1703
Practice Address - Country:US
Practice Address - Phone:503-416-5963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKPHAP1019183500000X, 183500000X
ORRPH-0012534183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist