Provider Demographics
NPI:1538341425
Name:DIMARCO, ANNA (RPH)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:
Last Name:DIMARCO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:RONDOS-DIMARCO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:1415 HEMPSTEAD TPKE
Mailing Address - Street 2:RITE AID PHARMACY
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-2404
Mailing Address - Country:US
Mailing Address - Phone:516-775-2813
Mailing Address - Fax:
Practice Address - Street 1:1415 HEMPSTEAD TPKE
Practice Address - Street 2:RITE AID PHARMACY
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-2404
Practice Address - Country:US
Practice Address - Phone:516-775-2813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036430-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00693554Medicaid