Provider Demographics
NPI:1679457766
Name:DIAZ QUINONES, GLORIANNE YARADIKZA (PHARMD)
Entity type:Individual
Prefix:
First Name:GLORIANNE
Middle Name:YARADIKZA
Last Name:DIAZ QUINONES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 RIVER PLACE DR UNIT 444
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-0061
Mailing Address - Country:US
Mailing Address - Phone:787-346-0704
Mailing Address - Fax:
Practice Address - Street 1:205 RIVER PLACE DR UNIT 444
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-0061
Practice Address - Country:US
Practice Address - Phone:787-346-0704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-02
Last Update Date:2025-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH035635183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist