Provider Demographics
NPI:1629671144
Name:DIESEL, ELIZABETH (RPH)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:DIESEL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ANNE
Other - Last Name:BERTOLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7001 MIAMI AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45243-2614
Mailing Address - Country:US
Mailing Address - Phone:513-561-7552
Mailing Address - Fax:513-561-0592
Practice Address - Street 1:7001 MIAMI AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45243-2614
Practice Address - Country:US
Practice Address - Phone:513-561-7552
Practice Address - Fax:513-561-0592
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03223658183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist