Kanae Dimaggio
Individual provider Active NPI Pharmacist · Gloucester, VA
NPI 1679956718 · NPPES record last updated Jul 7, 2015
Key facts
- NPI
- 1679956718
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 0202214022 (VA)
- Practice address
- 6908 Main St
Gloucester, VA 23061-5121 - Phone
- (804) 693-2160
- NPI assigned
- Jul 7, 2015
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0202214022 | VA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rite Aid of Virginia Inc | Past | Accepting new patients | |
| Rite Aid of Virginia Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 0202214022 | VA | Yes |
Addresses
Primary practice location
6908 Main St
Gloucester, VA 23061-5121
Mailing address
6908 Main St
Gloucester, VA 23061-5121
Other providers in Gloucester, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 7, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.