Provider Demographics
NPI:1184897878
Name:DEANDREA, DIANA MARGARET (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:MARGARET
Last Name:DEANDREA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:582 E PARKDALE DR
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-1766
Mailing Address - Country:US
Mailing Address - Phone:909-881-3778
Mailing Address - Fax:
Practice Address - Street 1:1710 BARTON RD
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-5304
Practice Address - Country:US
Practice Address - Phone:909-558-9225
Practice Address - Fax:909-558-9249
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 358761835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric