Healthcare Provider Details

I. General information

NPI: 1578428967
Provider Name (Legal Business Name): EMILY DIEP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 WELLNESS WAY STE 205
LATHAM NY
12110-2145
US

IV. Provider business mailing address

109 FAIRCREST RD
ROCHESTER NY
14623-4111
US

V. Phone/Fax

Practice location:
  • Phone: 518-641-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number073187
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: