Provider Demographics
NPI:1659793016
Name:DEICHLER, MARIANNE (RPH)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:DEICHLER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:881 MOUNTAIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-4213
Mailing Address - Country:US
Mailing Address - Phone:925-283-4785
Mailing Address - Fax:
Practice Address - Street 1:122 ROBLES WAY
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-8039
Practice Address - Country:US
Practice Address - Phone:707-554-6908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-20
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41518183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist