Provider Demographics
NPI:1629731963
Name:DIEP, MICHELLE DUYEN (PHARMACIST)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:DUYEN
Last Name:DIEP
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 BARLETT PL
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-3742
Mailing Address - Country:US
Mailing Address - Phone:714-234-8735
Mailing Address - Fax:
Practice Address - Street 1:517 N MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-4685
Practice Address - Country:US
Practice Address - Phone:714-953-6861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46308183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist