Provider Demographics
NPI:1235901604
Name:DEEGIDIO, JOSEPH EVAN (RPH, PHARMD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:EVAN
Last Name:DEEGIDIO
Suffix:
Gender:M
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4608 245TH ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11362-1146
Mailing Address - Country:US
Mailing Address - Phone:516-532-0598
Mailing Address - Fax:
Practice Address - Street 1:5125 MERRICK RD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA PARK
Practice Address - State:NY
Practice Address - Zip Code:11762-3728
Practice Address - Country:US
Practice Address - Phone:516-798-7676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071037183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist