Provider Demographics
NPI:1003050378
Name:DIRIENZO, KIM C (RPH)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:C
Last Name:DIRIENZO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3402 DELMAR DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-3538
Mailing Address - Country:US
Mailing Address - Phone:814-835-9212
Mailing Address - Fax:
Practice Address - Street 1:925 W ERIE PLZ
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4535
Practice Address - Country:US
Practice Address - Phone:814-454-7800
Practice Address - Fax:814-454-0600
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP040872L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist