Provider Demographics
NPI:1366767220
Name:EUMENIDI-ZORDA, DIANE (RPH)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:EUMENIDI-ZORDA
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:P.O. BOX 985
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06083
Mailing Address - Country:US
Mailing Address - Phone:860-763-7020
Mailing Address - Fax:860-763-7022
Practice Address - Street 1:31 MOODY RD.
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082
Practice Address - Country:US
Practice Address - Phone:860-763-7020
Practice Address - Fax:860-763-7022
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8356183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist