Healthcare Provider Details

I. General information

NPI: 1437433729
Provider Name (Legal Business Name): JOANNE DIFORMATO RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2011
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 JAMES L REDMAN PKWY
PLANT CITY FL
33563-7107
US

IV. Provider business mailing address

2202 JAMES L REDMAN PKWY
PLANT CITY FL
33563-7107
US

V. Phone/Fax

Practice location:
  • Phone: 401-741-0608
  • Fax:
Mailing address:
  • Phone: 813-752-2672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRPH04081
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPCT.0009168
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: