Provider Demographics
NPI:1841891355
Name:DIMARCO, NICOLA LYN (RPH)
Entity type:Individual
Prefix:
First Name:NICOLA
Middle Name:LYN
Last Name:DIMARCO
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 1:4312 SW GULL POINT DR
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64082-4686
Mailing Address - Country:US
Mailing Address - Phone:816-679-7663
Mailing Address - Fax:816-380-5237
Practice Address - Street 1:1700 N 291 HWY
Practice Address - Street 2:
Practice Address - City:HARRISONVILLE
Practice Address - State:MO
Practice Address - Zip Code:64701-1218
Practice Address - Country:US
Practice Address - Phone:816-884-2040
Practice Address - Fax:816-380-5237
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO044031183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist