Provider Demographics
NPI:1245608215
Name:DIEP, ANITA XUAN (RPH)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:XUAN
Last Name:DIEP
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4909 WERRE CT
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-3527
Mailing Address - Country:US
Mailing Address - Phone:916-402-3588
Mailing Address - Fax:
Practice Address - Street 1:2900 STOCKTON BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2302
Practice Address - Country:US
Practice Address - Phone:916-739-1621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73082183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist