Provider Demographics
NPI:1750967659
Name:DIEP, ANTHONY TAN (PHARMD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:TAN
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 1:14507 CIRCLEWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77062-2257
Mailing Address - Country:US
Mailing Address - Phone:832-938-1726
Mailing Address - Fax:
Practice Address - Street 1:1295 E LEAGUE CITY PKWY
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-6025
Practice Address - Country:US
Practice Address - Phone:281-332-8290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63174183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist