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NPI Code Detail

MEDICARE: MRS. KIMBERLY L. DIVITO PHARMD

MEDICARE: MRS. KIMBERLY L. DIVITO PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist03328462OH

General Provider Information

NPI Number : 1528357837
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KIMBERLY L. DIVITO PHARMD
Provider Business Mailing Address
First Line : 8790 KELLY LN
Second Line :
City : STREETSBORO
State : OH
Zip : 44241-4218
Country : US
Telephone Number : 330-301-9356
Fax Number :
Provider Business Practice Location Address
First Line : 21800 LIBBY RD
Second Line :
City : MAPLE HEIGHTS
State : OH
Zip : 44137-2947
Country : US
Telephone Number : 216-662-7470
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2011
Last Update Date : 04/07/2011

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Directions to “ MRS. KIMBERLY L. DIVITO PHARMD” Practice Location

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