Individual
DIANNE M PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2514 MAIN ST, LONGMONT, CO 80504-9740
(303) 774-9419
(303) 774-9427
Mailing address
2514 MAIN ST, LONGMONT, CO 80504-9740
(303) 774-9419
(303) 774-9427
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
13625
CO
Other
Enumeration date
04/13/2019
Last updated
04/13/2019
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