Provider Demographics
NPI:1205508934
Name:DIPIETRO, NICOLE (PHARMD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:DIPIETRO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 SHERMERHORN AVE
Mailing Address - Street 2:
Mailing Address - City:PUNXSUTAWNEY
Mailing Address - State:PA
Mailing Address - Zip Code:15767-2213
Mailing Address - Country:US
Mailing Address - Phone:814-249-2241
Mailing Address - Fax:
Practice Address - Street 1:307 E MARKET ST
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:PA
Practice Address - Zip Code:16830-2432
Practice Address - Country:US
Practice Address - Phone:813-765-7841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP456229183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP456229OtherLISENCE