| NPI | 1356940860 |
|---|---|
| Former Name | DIANE MEDEIROS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA 25778) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: RI RPH04561) |
| Enumeration Date | 2020-10-26 |
| Last Update Date | 2020-10-26 |