Provider Demographics
NPI:1962976357
Name:KRANNICH, DIANA (RPH,LMT)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:
Last Name:KRANNICH
Suffix:
Gender:F
Credentials:RPH,LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1247 SUSSEX TPKE STE 120
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-2943
Mailing Address - Country:US
Mailing Address - Phone:973-713-6989
Mailing Address - Fax:
Practice Address - Street 1:1247 SUSSEX TPKE STE 120
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-2943
Practice Address - Country:US
Practice Address - Phone:973-713-6989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00200500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty