Provider Demographics
NPI:1033404389
Name:THELEN, DIANA MARIE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:MARIE
Last Name:THELEN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4440 ALAMO STREET
Mailing Address - Street 2:CVS PHARMACY #9790
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063
Mailing Address - Country:US
Mailing Address - Phone:805-522-3120
Mailing Address - Fax:805-522-3120
Practice Address - Street 1:4440 ALAMO ST
Practice Address - Street 2:CVS PHARMACY #9790
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-1733
Practice Address - Country:US
Practice Address - Phone:805-522-3120
Practice Address - Fax:805-522-3120
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53646183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist