Provider Demographics
NPI:1417272378
Name:DELUISE, DEBORA ELAINE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DEBORA
Middle Name:ELAINE
Last Name:DELUISE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 BALSAM FIR LOOP
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-7501
Mailing Address - Country:US
Mailing Address - Phone:845-831-4765
Mailing Address - Fax:
Practice Address - Street 1:1429 ROUTE 300
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-2908
Practice Address - Country:US
Practice Address - Phone:845-566-4266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-05
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048325-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist