MEDICARE: THE DIENNET PHARMACY

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	3336C0004X	Compounding Pharmacy	44310	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	44310	OTHER	CA	CA BOARD OF PHARMACY LIC#

General Provider Information

NPI Number	:	1083982896
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE DIENNET PHARMACY

Provider Business Mailing Address
First Line	:	9454 WILSHIRE BLVD
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-2931
Country	:	US
Telephone Number	:	131-027-7343
Fax Number	:

Provider Business Practice Location Address
First Line	:	9454 WILSHIRE BLVD
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-2931
Country	:	US
Telephone Number	:	131-027-7343
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARCEL DIENNET
Credential	:	M.D.
Telephone Number	:	13102773436

Provider Enumeration Date	:	12/07/2011
Last Update Date	:	03/07/2023

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Directions to “THE DIENNET PHARMACY ” Practice Location

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