Provider Demographics
NPI:1437874666
Name:DIEHL, DAVID FREDERICK (PHARMD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:FREDERICK
Last Name:DIEHL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1554 E WOOD GLEN RD
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-4316
Mailing Address - Country:US
Mailing Address - Phone:801-554-8639
Mailing Address - Fax:
Practice Address - Street 1:3148 W 3500 S
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84119-3634
Practice Address - Country:US
Practice Address - Phone:801-963-2389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2774375-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty