Provider Demographics
NPI:1336416643
Name:DIEP, KENNY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KENNY
Middle Name:
Last Name:DIEP
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 1:1101 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5519
Mailing Address - Country:US
Mailing Address - Phone:215-629-5690
Mailing Address - Fax:215-629-5696
Practice Address - Street 1:1101 LOCUST ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5519
Practice Address - Country:US
Practice Address - Phone:215-629-5690
Practice Address - Fax:215-629-5696
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP444235183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist