=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497578488
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. ANNE FRANCES DELISA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2024
-----------------------------------------------------
Last Update Date | 11/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3300 CENTENNIAL LN
-----------------------------------------------------
City | ELLICOTT CITY
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21042-3600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-750-9439
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 111 N BEECHWOOD AVE
-----------------------------------------------------
City | CATONSVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21228-4928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-218-8612
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 12198
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------