Provider Demographics
NPI:1477157543
Name:DIEU, AU
Entity type:Individual
Prefix:
First Name:AU
Middle Name:
Last Name:DIEU
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 1:5781 80TH AVE N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-2224
Mailing Address - Country:US
Mailing Address - Phone:727-501-5765
Mailing Address - Fax:727-527-8345
Practice Address - Street 1:5405 49TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-2101
Practice Address - Country:US
Practice Address - Phone:727-527-8285
Practice Address - Fax:727-527-8345
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-29
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS45105183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist