Provider Demographics
NPI:1538482831
Name:MUSSALLI, DIANE REGINA (RPH)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:REGINA
Last Name:MUSSALLI
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 1:19922 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-1212
Mailing Address - Country:US
Mailing Address - Phone:718-352-5798
Mailing Address - Fax:
Practice Address - Street 1:19922 28TH AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-1212
Practice Address - Country:US
Practice Address - Phone:718-352-5798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046158183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist