Provider Demographics
NPI:1396082251
Name:DIMICCO, FRANK MICHAEL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:MICHAEL
Last Name:DIMICCO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 CACHE CAY DR
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32963-1210
Mailing Address - Country:US
Mailing Address - Phone:352-514-6750
Mailing Address - Fax:
Practice Address - Street 1:9621 N US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-6363
Practice Address - Country:US
Practice Address - Phone:772-581-5737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-12
Last Update Date:2013-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS43673183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist