Provider Demographics
NPI:1629855242
Name:DIGIROLAMO, TOM VITO (RPH)
Entity Type:Individual
Prefix:
First Name:TOM
Middle Name:VITO
Last Name:DIGIROLAMO
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 1:6108 NW 104TH TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64154-1787
Mailing Address - Country:US
Mailing Address - Phone:816-589-8795
Mailing Address - Fax:
Practice Address - Street 1:101 S MAPLE ST
Practice Address - Street 2:
Practice Address - City:ELDON
Practice Address - State:MO
Practice Address - Zip Code:65026-1811
Practice Address - Country:US
Practice Address - Phone:573-392-4588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO028778183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty