Diane Marie Foppe, RPH
Individual provider Active NPI Pharmacist · Breese, IL
NPI 1245822774 · NPPES record last updated Feb 5, 2021
Key facts
- NPI
- 1245822774
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 051037061 (IL)
- Practice address
- 117 Clintonian PLZ
Breese, IL 62230-1501 - Phone
- (618) 526-8040
- NPI assigned
- Feb 5, 2021
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051037061 | IL | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051037061 | IL | Yes |
Addresses
Primary practice location
117 Clintonian PLZ
Breese, IL 62230-1501
Mailing address
117 Clintonian PLZ
Breese, IL 62230-1501
Phone (618) 523-8040
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | ccrxcovid19vaccine@gmail.com | Direct |
Other providers in Breese, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 5, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.