Provider Demographics
NPI:1861091001
Name:DAVIS-YARBROUGH, DIANE CRESLYN (RPH)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:CRESLYN
Last Name:DAVIS-YARBROUGH
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 1:1135 TINY TREE DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-4103
Mailing Address - Country:US
Mailing Address - Phone:713-906-3994
Mailing Address - Fax:
Practice Address - Street 1:1300 W FAIRMONT PKWY
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:TX
Practice Address - Zip Code:77571-6102
Practice Address - Country:US
Practice Address - Phone:281-842-1022
Practice Address - Fax:281-842-1023
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20413183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist