Healthcare Provider Details

I. General information

NPI: 1235901604
Provider Name (Legal Business Name): JOSEPH EVAN DEEGIDIO RPH, PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2023
Last Update Date: 10/27/2023
Certification Date: 10/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5125 MERRICK RD
MASSAPEQUA PARK NY
11762-3728
US

IV. Provider business mailing address

4608 245TH ST
LITTLE NECK NY
11362-1146
US

V. Phone/Fax

Practice location:
  • Phone: 516-798-7676
  • Fax:
Mailing address:
  • Phone: 516-532-0598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number071037
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: