Provider Demographics
NPI:1538199922
Name:SCHELLACK, DIANE DENNIS (RPH)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:DENNIS
Last Name:SCHELLACK
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 1:620 BRANCH VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-3003
Mailing Address - Country:US
Mailing Address - Phone:770-640-7400
Mailing Address - Fax:404-329-2238
Practice Address - Street 1:1670 CLAIRMONT RD
Practice Address - Street 2:PHARMACY SERVICE -119
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-4004
Practice Address - Country:US
Practice Address - Phone:404-321-6111
Practice Address - Fax:404-329-2238
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11540183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist