MEDICARE: MISS JENNY DIEC PHARM D.

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	RP439325	PA
2	183500000X	Pharmacist	PS40635	FL

General Provider Information

NPI Number	:	1265709596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JENNY DIEC PHARM D.

Provider Business Mailing Address
First Line	:	127 MARLBOROUGH RD
Second Line	:
City	:	UPPER DARBY
State	:	PA
Zip	:	19082-3308
Country	:	US
Telephone Number	:	407-484-9097
Fax Number	:

Provider Business Practice Location Address
First Line	:	2655 S 10TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148-4403
Country	:	US
Telephone Number	:	215-467-6050
Fax Number	:

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

Provider Enumeration Date	:	12/01/2011
Last Update Date	:	12/01/2011

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Directions to “ MISS JENNY DIEC PHARM D.” Practice Location

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