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General NPI Number Information
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NPI Number | 1043357171
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Entity Type | Individual
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Provider Name | STEPHEN JOHN DIENES RPH
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Gender | Male
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 03/22/2010
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Provider Practice Location Address
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Address Line | NAVAJO ROUTE 4 - 2 MILES EAST OF PINON PINON HEALTH CLINIC
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City | PINON
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State | AZ
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Zip | 86510
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Country | US
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Telephone | 928-725-9514
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1417
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City | PINON
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State | AZ
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Zip | 86510-1417
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Country | US
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Telephone | 928-725-3032
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS 16309
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License Number State | FL
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