Individual
MRS. DIANA JOY DERUSSY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARM.D.
Contact information
Practice address
1600 EAST 23RD ST, CHATTANOOGA, TN 37404
(423) 629-4155
(423) 622-4558
Mailing address
1600 EAST 23RD STREET, CHATTANOOGA, TN 37404
(423) 629-4155
(423) 622-4558
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
022985
GA
183500000X
Pharmacist
Primary
37211
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
147401
NABP
TN
01
—
37211
TN PHARMACY LICENSE
TN
Enumeration date
09/07/2013
Last updated
02/02/2015
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