Healthcare Provider Details

I. General information

NPI: 1063148443
Provider Name (Legal Business Name): MARIA ANNE DIBELLA PHARMD, RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2022
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 CAMPBELL AVE
WEST HAVEN CT
06516-2705
US

IV. Provider business mailing address

15 BEACH PL
BRANFORD CT
06405-3703
US

V. Phone/Fax

Practice location:
  • Phone: 203-932-5711
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberP10168
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: