Healthcare Provider Details

I. General information

NPI: 1326090820
Provider Name (Legal Business Name): FRANK ANTHONY DELLISANTI RPH.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 DEER SHORE SQ
NORTH BABYLON NY
11703-1207
US

IV. Provider business mailing address

1 DEFEO CT
DEER PARK NY
11729-1841
US

V. Phone/Fax

Practice location:
  • Phone: 631-667-2484
  • Fax: 631-667-8887
Mailing address:
  • Phone: 631-243-0657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number035361
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: