Healthcare Provider Details

I. General information

NPI: 1700124476
Provider Name (Legal Business Name): DOMINIQUE CIPOLLONE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2013
Last Update Date: 01/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 AMERICAN ST
CATASAUQUA PA
18032-1800
US

IV. Provider business mailing address

300 AMERICAN ST
CATASAUQUA PA
18032-1800
US

V. Phone/Fax

Practice location:
  • Phone: 610-264-5471
  • Fax: 610-264-3048
Mailing address:
  • Phone: 610-264-5471
  • Fax: 610-264-3048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP447128
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: