Provider Demographics
NPI:1548864663
Name:DIMICHELE, EDWARD ANTHONY (RPH)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:ANTHONY
Last Name:DIMICHELE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E KOSSUTH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43206-2216
Mailing Address - Country:US
Mailing Address - Phone:614-406-0249
Mailing Address - Fax:
Practice Address - Street 1:4801 W BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-1601
Practice Address - Country:US
Practice Address - Phone:614-878-7565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-327077183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist