MEDICARE: JENNIFER DIEN PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	71402	CA
2	183500000X	Pharmacist	18825	NV

General Provider Information

NPI Number	:	1720457294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER DIEN PHARM.D.

Provider Business Mailing Address
First Line	:	3670 S NOGALES ST
Second Line	:
City	:	WEST COVINA
State	:	CA
Zip	:	91792-2714
Country	:	US
Telephone Number	:	626-912-7031
Fax Number	:

Provider Business Practice Location Address
First Line	:	3670 S NOGALES ST
Second Line	:
City	:	WEST COVINA
State	:	CA
Zip	:	91792-2714
Country	:	US
Telephone Number	:	626-912-7031
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2015
Last Update Date	:	09/15/2015

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