Provider Demographics
NPI:1598254609
Name:AMBARTSUMYAN, DIANNA (PHARM D)
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:
Last Name:AMBARTSUMYAN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1366 S RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-7608
Mailing Address - Country:US
Mailing Address - Phone:909-820-7635
Mailing Address - Fax:909-875-9588
Practice Address - Street 1:1366 S RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-7608
Practice Address - Country:US
Practice Address - Phone:909-820-7635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62170183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist