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NPI Code Detail

MEDICARE: DR. ELLEN DIEP PHARMD

MEDICARE: DR. ELLEN DIEP PHARMD
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
1183500000XPharmacist42106TN

General Provider Information

NPI Number : 1225632060
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ELLEN DIEP PHARMD
Provider Business Mailing Address
First Line : 920 N STATE OF FRANKLIN RD
Second Line :
City : JOHNSON CITY
State : TN
Zip : 37604-3668
Country : US
Telephone Number : 423-232-9015
Fax Number : 423-232-9018
Provider Business Practice Location Address
First Line : 920 N STATE OF FRANKLIN RD
Second Line :
City : JOHNSON CITY
State : TN
Zip : 37604-3668
Country : US
Telephone Number : 423-232-9015
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/23/2020
Last Update Date : 11/23/2020

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Directions to “ DR. ELLEN DIEP PHARMD” Practice Location

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