Provider Demographics
NPI:1841512332
Name:DIEPPA, KENNETH (RPH)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:
Last Name:DIEPPA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-2416
Mailing Address - Country:US
Mailing Address - Phone:718-448-6486
Mailing Address - Fax:718-448-7146
Practice Address - Street 1:1227 FOREST AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-2416
Practice Address - Country:US
Practice Address - Phone:718-448-6486
Practice Address - Fax:718-448-7146
Is Sole Proprietor?:No
Enumeration Date:2010-02-24
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043821183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist