Healthcare Provider Details

I. General information

NPI: 1588962955
Provider Name (Legal Business Name): PAUL ALBERT DEFELICE PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2011
Last Update Date: 03/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 POLLY DRUMMOND SHPG CTR
NEWARK DE
19711-4859
US

IV. Provider business mailing address

7 RAPHAEL RD
HOCKESSIN DE
19707-2209
US

V. Phone/Fax

Practice location:
  • Phone: 302-731-9111
  • Fax:
Mailing address:
  • Phone: 302-235-7123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberA1-0002241
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: