Provider Demographics
NPI:1699982751
Name:CARPENTER, DIANNE C (PHARMD)
Entity type:Individual
Prefix:
First Name:DIANNE
Middle Name:C
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14215 BLAMER RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43031-9608
Mailing Address - Country:US
Mailing Address - Phone:614-348-3641
Mailing Address - Fax:
Practice Address - Street 1:350 E BROAD ST
Practice Address - Street 2:
Practice Address - City:PATASKALA
Practice Address - State:OH
Practice Address - Zip Code:43062-9551
Practice Address - Country:US
Practice Address - Phone:740-964-5105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-26626183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist