Provider Demographics
NPI:1700034279
Name:DIBERT, DEBRA S (RPH)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:S
Last Name:DIBERT
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 1:21991 W STATE ROUTE 51
Mailing Address - Street 2:
Mailing Address - City:GENOA
Mailing Address - State:OH
Mailing Address - Zip Code:43430-1251
Mailing Address - Country:US
Mailing Address - Phone:419-855-8363
Mailing Address - Fax:
Practice Address - Street 1:21991 W STATE ROUTE 51
Practice Address - Street 2:
Practice Address - City:GENOA
Practice Address - State:OH
Practice Address - Zip Code:43430-1251
Practice Address - Country:US
Practice Address - Phone:419-855-8363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH032140431835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist