Provider Demographics
NPI:1699977355
Name:REIST, DIANE KAY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:KAY
Last Name:REIST
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3405 76TH AVENUE DR SW
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404-8929
Mailing Address - Country:US
Mailing Address - Phone:319-899-8887
Mailing Address - Fax:319-356-0052
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:PHARMACY DEPT. GH C-23-D
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-353-8807
Practice Address - Fax:319-356-8443
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA159151835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist