Healthcare Provider Details

I. General information

NPI: 1508792482
Provider Name (Legal Business Name): MARIA DITTRICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 SE 32ND ST
CAPE CORAL FL
33904-4100
US

IV. Provider business mailing address

133 SE 32ND ST
CAPE CORAL FL
33904-4100
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-5302
  • Fax:
Mailing address:
  • Phone: 239-343-5302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS57532
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: