Provider Demographics
NPI:1215256193
Name:FEDERICO, DANA LYNN (RPH)
Entity type:Individual
Prefix:MRS
First Name:DANA
Middle Name:LYNN
Last Name:FEDERICO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 DUNN RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-6795
Mailing Address - Country:US
Mailing Address - Phone:724-216-5639
Mailing Address - Fax:
Practice Address - Street 1:177 DUNN RD
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-6795
Practice Address - Country:US
Practice Address - Phone:724-216-5639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP038222L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist