Provider Demographics
NPI:1699350868
Name:DIANAT, SAM (PHARMD)
Entity type:Individual
Prefix:
First Name:SAM
Middle Name:
Last Name:DIANAT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7513 RICHLAND RD
Mailing Address - Street 2:
Mailing Address - City:RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76118-5529
Mailing Address - Country:US
Mailing Address - Phone:817-818-6654
Mailing Address - Fax:
Practice Address - Street 1:5401 LEBANON RD
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-5150
Practice Address - Country:US
Practice Address - Phone:972-624-8170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67881183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist