Provider Demographics
NPI:1710437496
Name:VITO, DEANNE KNICK (RPH)
Entity type:Individual
Prefix:
First Name:DEANNE
Middle Name:KNICK
Last Name:VITO
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 1:1328 MARTIN CREEK DR
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-3399
Mailing Address - Country:US
Mailing Address - Phone:336-456-0952
Mailing Address - Fax:
Practice Address - Street 1:200 N COOPER DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-4016
Practice Address - Country:US
Practice Address - Phone:336-852-0997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-06
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15745183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist