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General NPI Number Information
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NPI Number | 1508670456
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Entity Type | Individual
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Provider Name | MARK BRUCE DELEVAN I PHARMD
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Gender | Male
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Dates
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Enumeration Date | 02/03/2025
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 317 NASSAU BLVD
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City | GARDEN CITY SOUTH
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State | NY
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Zip | 11530-5313
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Country | US
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Telephone | 516-292-2961
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Fax |
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Provider Business Mailing Address
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Address Line | 6474 80TH ST
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City | MIDDLE VILLAGE
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State | NY
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Zip | 11379-2310
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Country | US
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Telephone | 646-300-3821
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 072463
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License Number State | NY
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