Provider Demographics
NPI:1629523089
Name:SHEN, DIANA (PHARMD)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:SHEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39331 CANYON HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-3076
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3801 HOWE ST
Practice Address - Street 2:FABIOLA G-25
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5312
Practice Address - Country:US
Practice Address - Phone:510-752-6141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74859183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist