Provider Demographics
NPI:1053788075
Name:DIEC, SANDY (PHARMD)
Entity type:Individual
Prefix:
First Name:SANDY
Middle Name:
Last Name:DIEC
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 W CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-7124
Mailing Address - Country:US
Mailing Address - Phone:832-552-5995
Mailing Address - Fax:
Practice Address - Street 1:1206 W CAMPUS DR
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-7124
Practice Address - Country:US
Practice Address - Phone:832-552-5995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX56970183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist