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General NPI Number Information
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NPI Number | 1164539235
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Entity Type | Individual
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Provider Name | DIANE MARIE POLOMBO RPH
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Gender | Female
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Dates
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Enumeration Date | 08/24/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 25 CHURCH ST
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City | WILKES BARRE
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State | PA
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Zip | 18765-0999
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Country | US
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Telephone | 570-826-3573
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Fax | 570-831-8967
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Provider Business Mailing Address
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Address Line | 23 ORCHARD ST
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City | TRUCKSVILLE
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State | PA
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Zip | 18708-1620
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Country | US
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Telephone | 570-696-4008
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | RP037502L
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License Number State | PA
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