Provider Demographics
NPI:1164704607
Name:AN, HUONG DIEM (PHARMACIST)
Entity Type:Individual
Prefix:MISS
First Name:HUONG
Middle Name:DIEM
Last Name:AN
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 BEACON ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-4311
Mailing Address - Country:US
Mailing Address - Phone:617-497-5763
Mailing Address - Fax:617-497-3945
Practice Address - Street 1:16 BEACON ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-4311
Practice Address - Country:US
Practice Address - Phone:617-497-5763
Practice Address - Fax:617-497-3945
Is Sole Proprietor?:No
Enumeration Date:2011-09-11
Last Update Date:2011-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH24522183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist