Provider Demographics
NPI:1891017166
Name:DIMINO, ROSA (RPH)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:
Last Name:DIMINO
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 1:7002 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-1604
Mailing Address - Country:US
Mailing Address - Phone:718-921-1896
Mailing Address - Fax:718-238-1586
Practice Address - Street 1:7002 13TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-1604
Practice Address - Country:US
Practice Address - Phone:718-921-1896
Practice Address - Fax:718-238-1586
Is Sole Proprietor?:No
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045020183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist