Active NPI
Daniel Dibacco, PHARMD
- Pharmacist
- Marietta, GA
National Provider Identifier
1164546685
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 021517
- Practice address
- 2200 Roswell Rd
Marietta, GA 30062-2983 - Phone
- (770) 973-7337
- NPI assigned
- Mar 19, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 021517 | GA | Primary |
Addresses
Primary practice location
2200 Roswell Rd
Marietta, GA 30062-2983
Mailing address
136 Peachtree Memorial Dr NW
Pennyslvania #7
Atlanta, GA 30309-1096
Phone (404) 808-2722
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 021517 | GA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174262400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1164546685",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "136 PEACHTREE MEMORIAL DR NW",
"address_2": "PENNYSLVANIA #7",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303091096",
"telephone_number": "404-808-2722"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2200 ROSWELL RD",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300622983",
"telephone_number": "770-973-7337"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIBACCO",
"first_name": "DANIEL",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "021517",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marietta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.