Healthcare Provider Details

I. General information

NPI: 1972039675
Provider Name (Legal Business Name): MARCO DELBOVE PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2017
Last Update Date: 05/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 VIRGINIA AVE SUITE 107
PROVIDENCE RI
02905-4406
US

IV. Provider business mailing address

17 VIRGINIA AVE SUITE 107
PROVIDENCE RI
02905-4406
US

V. Phone/Fax

Practice location:
  • Phone: 401-443-4996
  • Fax: 401-784-4902
Mailing address:
  • Phone: 401-443-4996
  • Fax: 401-784-4902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH04930
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRPH04930
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberRPH04930
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: