Provider Demographics
NPI:1447572185
Name:DELUCA, ALFONSO (PHARMD)
Entity Type:Individual
Prefix:
First Name:ALFONSO
Middle Name:
Last Name:DELUCA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 68TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-6008
Mailing Address - Country:US
Mailing Address - Phone:718-514-0873
Mailing Address - Fax:
Practice Address - Street 1:120 FIELDCREST AVE
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-3656
Practice Address - Country:US
Practice Address - Phone:732-346-2600
Practice Address - Fax:732-225-5263
Is Sole Proprietor?:No
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03188400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist