Basic Information
Provider Information | |||||||||
NPI: | 1003152349 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | EICKMEIER | ||||||||
FirstName: | DIANE | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | RPH | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2053 CARDINAL DR | ||||||||
Address2: |   | ||||||||
City: | DANVILLE | ||||||||
State: | KY | ||||||||
PostalCode: | 404229731 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8592367375 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 60 CASSIDY WAY | ||||||||
Address2: |   | ||||||||
City: | DANVILLE | ||||||||
State: | KY | ||||||||
PostalCode: | 404228457 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8599361222 | ||||||||
FaxNumber: | 8599362003 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/13/2012 | ||||||||
LastUpdateDate: | 12/13/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 012384 | KY | Y |   | Pharmacy Service Providers | Pharmacist |   | 183500000X | 051035842 | IL | N |   | Pharmacy Service Providers | Pharmacist |   |
No ID Information.