Provider Demographics
NPI:1194007716
Name:DELVESCO, AMBER N (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:N
Last Name:DELVESCO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7452 MARRISEY LOOP
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:OH
Mailing Address - Zip Code:43021-7048
Mailing Address - Country:US
Mailing Address - Phone:740-936-8028
Mailing Address - Fax:
Practice Address - Street 1:6201 E BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-5500
Practice Address - Country:US
Practice Address - Phone:614-367-7526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-10
Last Update Date:2011-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03226132183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist