MEDICARE: MR. BRIAN MATTHEW DELP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS29431	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PS29431	OTHER	FL	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1962603050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRIAN MATTHEW DELP

Provider Business Mailing Address
First Line	:	2201 WEDGEWOOD CT
Second Line	:
City	:	PLANT CITY
State	:	FL
Zip	:	33566-0923
Country	:	US
Telephone Number	:	813-759-2617
Fax Number	:	813-759-2617

Provider Business Practice Location Address
First Line	:	2602 JAMES L REDMAN PKWY
Second Line	:
City	:	PLANT CITY
State	:	FL
Zip	:	33566-9460
Country	:	US
Telephone Number	:	813-752-5765
Fax Number	:	813-754-1179

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2007
Last Update Date	:	07/06/2021

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