Provider Demographics
NPI:1255467890
Name:DIBIASE, ANTHONY P (RPH)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:P
Last Name:DIBIASE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2899 KINLOCH RD
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-1713
Mailing Address - Country:US
Mailing Address - Phone:516-221-0805
Mailing Address - Fax:516-409-9207
Practice Address - Street 1:2410 MERRICK RD
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-5701
Practice Address - Country:US
Practice Address - Phone:516-409-9096
Practice Address - Fax:516-409-9207
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036036183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist