Provider Demographics
NPI:1730321530
Name:DIMARCO, KEITH (R PH)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:
Last Name:DIMARCO
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 WHEATLEY AVE
Mailing Address - Street 2:
Mailing Address - City:ALBERTSON
Mailing Address - State:NY
Mailing Address - Zip Code:11507-1515
Mailing Address - Country:US
Mailing Address - Phone:516-747-0257
Mailing Address - Fax:
Practice Address - Street 1:275 BROADWAY
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2708
Practice Address - Country:US
Practice Address - Phone:631-841-1630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-25
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036037183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist