Provider Demographics
NPI:1669866042
Name:DIAZ, EDDIE LEE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:EDDIE
Middle Name:LEE
Last Name:DIAZ
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3102 E HIGHLAND AVE
Mailing Address - Street 2:MAIN PHAMACY
Mailing Address - City:PATTON
Mailing Address - State:CA
Mailing Address - Zip Code:92369-7813
Mailing Address - Country:US
Mailing Address - Phone:909-425-7450
Mailing Address - Fax:909-425-6297
Practice Address - Street 1:3102 E HIGHLAND AVE
Practice Address - Street 2:MAIN PHAMACY
Practice Address - City:PATTON
Practice Address - State:CA
Practice Address - Zip Code:92369-7813
Practice Address - Country:US
Practice Address - Phone:909-425-7450
Practice Address - Fax:909-425-6297
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-24
Last Update Date:2017-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA689211835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist