Provider Demographics
NPI:1841592516
Name:DIESH, ANDREW BEN
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:BEN
Last Name:DIESH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3902 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-4954
Mailing Address - Country:US
Mailing Address - Phone:510-490-6695
Mailing Address - Fax:
Practice Address - Street 1:3902 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-4954
Practice Address - Country:US
Practice Address - Phone:510-490-6695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46227183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist