Provider Demographics
NPI:1912504887
Name:DINH, SANDY DIEM (RPH)
Entity Type:Individual
Prefix:
First Name:SANDY
Middle Name:DIEM
Last Name:DINH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20938 STRATHERN ST
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91304-5132
Mailing Address - Country:US
Mailing Address - Phone:818-641-7731
Mailing Address - Fax:
Practice Address - Street 1:1356 W AVENUE J
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2936
Practice Address - Country:US
Practice Address - Phone:661-948-3343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83158183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist