Healthcare Provider Details

I. General information

NPI: 1750124962
Provider Name (Legal Business Name): KIMBERLY ANN DIMPEL R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2024
Last Update Date: 06/15/2024
Certification Date: 06/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 N CENTRAL AVE
CANONSBURG PA
15317-1301
US

IV. Provider business mailing address

1 N CENTRAL AVE
CANONSBURG PA
15317-1301
US

V. Phone/Fax

Practice location:
  • Phone: 724-745-6480
  • Fax: 724-916-4957
Mailing address:
  • Phone: 724-745-6480
  • Fax: 724-916-4957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP041785L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: