Provider Demographics
NPI:1366729345
Name:LAHEY, DIANE MARIE
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:MARIE
Last Name:LAHEY
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 1:2111 WINDING RIVER ROAD
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-8508
Mailing Address - Country:US
Mailing Address - Phone:630-904-4760
Mailing Address - Fax:630-904-4849
Practice Address - Street 1:2111 WINDING RIVER ROAD
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-8508
Practice Address - Country:US
Practice Address - Phone:630-904-4760
Practice Address - Fax:630-904-4849
Is Sole Proprietor?:No
Enumeration Date:2011-11-04
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051035080183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist