MEDICARE: LINDSEY DIEDERICH

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	42603	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215548177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDSEY DIEDERICH

Provider Business Mailing Address
First Line	:	2399 MCGRADY DR SE
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37323-7147
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2399 MCGRADY DR SE
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37323-7147
Country	:	US
Telephone Number	:	423-559-9094
Fax Number	:

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

Provider Enumeration Date	:	08/13/2020
Last Update Date	:	08/13/2020

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Directions to “ LINDSEY DIEDERICH ” Practice Location

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