Provider Demographics
NPI:1447844121
Name:FORREST, DIANA (RPH)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:FORREST
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:BOWERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1340
Mailing Address - Street 2:
Mailing Address - City:OKANOGAN
Mailing Address - State:WA
Mailing Address - Zip Code:98840-1340
Mailing Address - Country:US
Mailing Address - Phone:509-689-3455
Mailing Address - Fax:855-204-8847
Practice Address - Street 1:525 JAY AVE
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:WA
Practice Address - Zip Code:98812-3403
Practice Address - Country:US
Practice Address - Phone:509-689-3455
Practice Address - Fax:855-204-8847
Is Sole Proprietor?:No
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH61040215183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist