Provider Demographics
NPI:1730230079
Name:KONECHNE, DIANE LYNN (RPH)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:LYNN
Last Name:KONECHNE
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 1:1504 PEBBLE BEACH RD
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-5015
Mailing Address - Country:US
Mailing Address - Phone:605-996-4438
Mailing Address - Fax:
Practice Address - Street 1:818 W HAVENS ST
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-3830
Practice Address - Country:US
Practice Address - Phone:605-996-5321
Practice Address - Fax:605-996-6090
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD3718183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist