Provider Demographics
NPI:1144692575
Name:KADIWAR, DIPALI (RPH)
Entity type:Individual
Prefix:MRS
First Name:DIPALI
Middle Name:
Last Name:KADIWAR
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 1:22920 STATE ROAD 54
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-6931
Mailing Address - Country:US
Mailing Address - Phone:813-949-7872
Mailing Address - Fax:847-396-2725
Practice Address - Street 1:22920 STATE ROAD 54
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-6931
Practice Address - Country:US
Practice Address - Phone:813-949-7872
Practice Address - Fax:847-396-2725
Is Sole Proprietor?:No
Enumeration Date:2015-10-25
Last Update Date:2015-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI24185183500000X
FLPS38704183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist