Provider Demographics
NPI:1497132534
Name:DIEP, JOHN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:DIEP
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 1:11500 BROOKSHIRE AVE
Mailing Address - Street 2:DEPARTMENT OF PHARMACY
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-4917
Mailing Address - Country:US
Mailing Address - Phone:562-904-5511
Mailing Address - Fax:
Practice Address - Street 1:11500 BROOKSHIRE AVE
Practice Address - Street 2:DEPARTMENT OF PHARMACY
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-4917
Practice Address - Country:US
Practice Address - Phone:562-904-5511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69391183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist