Individual
DIANE NICOLE GUTGSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
1717 S CALHOUN ST, FORT WAYNE, IN 46802-5257
(260) 458-2641
Mailing address
12853 SLASH PASS, FORT WAYNE, IN 46818-0062
(812) 881-1741
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
5302414434
MI
1835P1200X
Pharmacotherapy Pharmacist
Primary
26030090A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26030090A
PHARMACIST LICENSE
IN
01
—
5302414434
PHARMACIST LICENSE NUMBER
MI
Enumeration date
08/19/2022
Last updated
05/02/2025
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