Provider Demographics
NPI:1326330168
Name:DEDIONISIO, DEBORAH K (RPH)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:K
Last Name:DEDIONISIO
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 1:4145 BUFFALO RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16510-2109
Mailing Address - Country:US
Mailing Address - Phone:814-899-6924
Mailing Address - Fax:814-899-3274
Practice Address - Street 1:4145 BUFFALO RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16510-2109
Practice Address - Country:US
Practice Address - Phone:814-899-6924
Practice Address - Fax:814-899-3274
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP034128L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist