Provider Demographics
NPI:1316472558
Name:PREPELITSKY, DIANA ISABELLA (PHARMD)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:ISABELLA
Last Name:PREPELITSKY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 AVENUE OF THE STARS
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-4700
Mailing Address - Country:US
Mailing Address - Phone:310-277-6123
Mailing Address - Fax:
Practice Address - Street 1:2000 AVENUE OF THE STARS
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067
Practice Address - Country:US
Practice Address - Phone:310-277-6123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-25
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76338183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist