Provider Demographics
NPI:1962132423
Name:DIEP, CASEY (PHARMD)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
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 1:13411 BENTON ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-3275
Mailing Address - Country:US
Mailing Address - Phone:714-824-7259
Mailing Address - Fax:
Practice Address - Street 1:9482 CALIFORNIA CITY BLVD
Practice Address - Street 2:
Practice Address - City:CALIFORNIA CITY
Practice Address - State:CA
Practice Address - Zip Code:93505-2803
Practice Address - Country:US
Practice Address - Phone:760-373-5268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85962183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist