Provider Demographics
NPI:1255646204
Name:PASTOREK, DIANE MARIE
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:PASTOREK
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 1:114 TANGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:PA
Mailing Address - Zip Code:16059-2552
Mailing Address - Country:US
Mailing Address - Phone:724-898-2541
Mailing Address - Fax:
Practice Address - Street 1:4960 WILLIAM FLYNN HWY
Practice Address - Street 2:SUITE 10
Practice Address - City:ALLISON PARK
Practice Address - State:PA
Practice Address - Zip Code:15101-2354
Practice Address - Country:US
Practice Address - Phone:724-443-5455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-15
Last Update Date:2010-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP031830L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist