Provider Demographics
NPI:1144368044
Name:ZAMUDIO, DIANE BARBARA (RPH)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:BARBARA
Last Name:ZAMUDIO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:297 DEER RUN
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-6463
Mailing Address - Country:US
Mailing Address - Phone:254-634-1380
Mailing Address - Fax:
Practice Address - Street 1:BLDG 36000 DARNALL LOOP
Practice Address - Street 2:
Practice Address - City:FT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-288-8830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26781183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist