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Individual
MR. KEITH DIAMOND
Active
Individual
MR. KEITH DIAMOND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
R.PH., C.PED
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
034707
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
034707
STATE BOARD OF PHARMACY LICENSE
NY
01
—
9912
CERTIFIED PEDORTHIST
—
01
—
CFO00361
CERTIFIED FITTER - ORTHOTICS
—
Enumeration date
03/02/2009
Last updated
03/02/2009
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