Provider Demographics
NPI:1063829687
Name:DIMIAN, MINA
Entity Type:Individual
Prefix:
First Name:MINA
Middle Name:
Last Name:DIMIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3021 E CHERRY HILLS PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-3923
Mailing Address - Country:US
Mailing Address - Phone:917-421-0408
Mailing Address - Fax:
Practice Address - Street 1:1695 N ARIZONA BLVD
Practice Address - Street 2:
Practice Address - City:COOLIDGE
Practice Address - State:AZ
Practice Address - Zip Code:85128-9128
Practice Address - Country:US
Practice Address - Phone:520-723-0950
Practice Address - Fax:520-723-8665
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS018316183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZS018316OtherARIZONA PHARMACIST LICENSE