Provider Demographics
NPI:1255611968
Name:MOCH, DIANE E (RPH)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:E
Last Name:MOCH
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 1:1126 E LYNCHBURG SALEM TPKE
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24523-3446
Mailing Address - Country:US
Mailing Address - Phone:540-586-6012
Mailing Address - Fax:
Practice Address - Street 1:1126 E LYNCHBURG SALEM TPKE
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:VA
Practice Address - Zip Code:24523-3446
Practice Address - Country:US
Practice Address - Phone:540-586-6012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2015-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202204500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist