Healthcare Provider Details

I. General information

NPI: 1467517003
Provider Name (Legal Business Name): JEFFREY C DELAFUENTE M.S., R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 N. 12TH STREET
RICHMOND VA
23298-0581
US

IV. Provider business mailing address

6000 BRENTMOOR DR
GLEN ALLEN VA
23059-7005
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-7831
  • Fax: 804-827-0002
Mailing address:
  • Phone: 804-360-7042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number0202205589
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: