DIANE CLARK (NPI# 1558634980) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558634980 |
| Entity Type | Individual |
| Full Name | DIANE CLARK |
| Credential | R.PH. |
| Practice Address |
3639 Crater Lake Hwy Medford OR 97504-9259 |
| Practice Telephone | 5417342482 |
| Mailing Telephone | 5417342482 |
| Enumeration Date | 2012-02-15 |
| Last Update Date | 2016-01-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183500000X | Pharmacist | 7948 | OR | Pharmacy Service Providers |
| N | 1835P0018X |
Pharmacist Specialization: Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
7948 | OR | Pharmacy Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841767449 | Diane Clark | Registered Nurse | 8219 Golden Hbr, Missouri City, TX 77459-6905 | 2018-11-01 |
| 1669612644 | Diane M Clark | Counselor | 1557 Brandon Sq, Lawrenceville, GA 30044-3016 | 2009-03-03 |
| 1922563139 | Diane Faith Clark | Psychologist | 25631 Peter A Hartman Way, Mission Viejo, CA 92691-3142 | 2019-02-01 |
| 1952763377 | Diane Clark | Registered Nurse | 1118 F St, Lewiston, ID 83501-1930 | 2016-03-24 |
| 1225419096 | Diane Clark | Social Worker | 1115 Westport Dr Ste D2, Manhattan, KS 66502-2871 | 2015-06-17 |
| 1164832887 | Diane Clark | Counselor | 233 S Quintana Dr, Anaheim, CA 92807 | 2014-05-02 |
| 1881863488 | Diane K Clark | Nurse Practitioner | 9427 Sw Barnes Rd, Ste 595, Portland, OR 97225-6640 | 2008-02-27 |
| 1841406261 | Diane E. Clark | Counselor | 200 Washington St, Suite 205, Watertown, NY 13601-3335 | 2007-05-15 |
| 1306994637 | Diane Marie Clark | Chiropractor | 4705 S Clyde Morris Blvd, Port Orange, FL 32129-4103 | 2007-01-05 |
| 1306941166 | Diane Maxine Clark | Physical Therapist | 13560 Wayzata Blvd, Minnetonka, MN 55305-1850 | 2006-09-14 |
| Street Address |
3639 CRATER LAKE HWY |
| City | MEDFORD |
| State | OR |
| Zip Code | 97504-9259 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659491777 | Stephen Allen Barnes | Optometrist | 3639 Crater Lake Hwy, Medford, OR 97504-9259 | 2007-03-30 |
| 1396110805 | Robert Piatt | Pharmacist | 3639 Crater Lake Hwy, Medford, OR 97504-9259 | 2015-12-09 |
| 1013290352 | Greg Alan Bryan | Pharmacist | 3639 Crater Lake Hwy, Pharmacy, Medford, OR 97504-9259 | 2011-09-22 |
| 1164712543 | Jeffrey Scott Gerschler | Pharmacist | 3639 Crater Lake Hwy, Medford, OR 97504-9259 | 2011-04-19 |
| 1932499480 | Scott Koester | Pharmacist | 3639 Crater Lake Hwy, Medford, OR 97504-9259 | 2011-04-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225673833 | Lydia D Sneed | Behavioral Analyst | 3707 Citation Way, Suite 102, Medford, OR 97504 | 2019-11-07 |
| 1114577368 | Heather Ashley Fronek | Nurse Practitioner | 2825 E. Barnett Rd., Medford, OR 97504 | 2019-09-18 |
| 1255809109 | Justin Blasdel | Technician, Health Information | 3250 Lone Pine Rd, Medford, OR 97504 | 2018-11-08 |
| 1396220133 | Aimee K Michel | Massage Therapist | 3550 National Dr., Medford, OR 97504 | 2018-09-27 |
| 1437646908 | Zola Dental Medford LLC | Dentist | 922 E Main, Medford, OR 97504 | 2018-04-19 |
| 1376068015 | Megan Leggett | Counselor | 777 Murphy Road, Medford, OR 97504 | 2017-08-03 |
| 1023547536 | Joshua Morgan Rice | Dentist | 1117 E Main St Ste 1, Medford, OR 97504 | 2017-06-08 |
| 1427580232 | Paul James Dean | Counselor | 1175 Main St Ste 1c, Medford, OR 97504 | 2017-03-30 |
| 1811443542 | Taya Adams | Doula | 1201 Progress Dr #90, Medford, OR 97504 | 2016-09-01 |
| 1174076228 | Avalon Health Care - Hearthstone, LLC | Skilled Nursing Facility | 2091 E. Barnett Road, Medford, OR 97504 | 2016-07-25 |
| Find all providers in zip 97504 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386245934 | Stephen Choi | Pharmacist | 12 Blakely Rd, Medford, MA 02155-2409 | 2020-11-02 |
| 1366084592 | Michael Kasik | Pharmacist | 701 Black Oak Dr, Medford, OR 97504-8550 | 2019-10-09 |
| 1316594898 | Christ Ange G Katche | Pharmacist | 21 College Ave Apt 1, Medford, MA 02155-4571 | 2019-08-20 |
| 1295203677 | Hajar Taman | Pharmacist | 2975 Horseblock Road, Medford, NY 11763 | 2018-11-05 |
| 1770059537 | Kamal Kotaich | Pharmacist | 140 S Holly St Ste 1131, Medford, OR 97501-3113 | 2018-10-19 |
| 1851778211 | Kyle Mason | Pharmacist | 34 Tallowood Dr, Medford, NJ 08055-9147 | 2015-05-05 |
| 1174931331 | Justina Sokolovas | Pharmacist | 1350 Center Drive, Pharmacy Department, Medford, OR 97501 | 2014-07-31 |
| 1295152759 | Marvin Wainwright | Pharmacist | 5 Wilkins Station Rd, Suite 100, Medford, NJ 08055-9606 | 2014-03-23 |
| 1780008466 | Catherine Rimov | Pharmacist | 4449 Vista Pointe Dr, Medford, OR 97504-8084 | 2014-02-14 |
| 1992141584 | Jerry C Hood | Pharmacist | 2425 Nieto Way, Medford, OR 97504-8577 | 2013-05-22 |
| Find all providers in MEDFORD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.