Provider Demographics
NPI:1174738090
Name:MARN, DIANE M
Entity type:Individual
Prefix:MR
First Name:DIANE
Middle Name:M
Last Name:MARN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3545 BIG PINE RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32934-8559
Mailing Address - Country:US
Mailing Address - Phone:321-752-9918
Mailing Address - Fax:
Practice Address - Street 1:3545 BIG PINE RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32934-8559
Practice Address - Country:US
Practice Address - Phone:321-752-9918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician