Provider Demographics
NPI:1467517003
Name:DELAFUENTE, JEFFREY C (MS, RPH)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:C
Last Name:DELAFUENTE
Suffix:
Gender:M
Credentials:MS, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 BRENTMOOR DR
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-7005
Mailing Address - Country:US
Mailing Address - Phone:804-360-7042
Mailing Address - Fax:
Practice Address - Street 1:410 N. 12TH STREET
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-0581
Practice Address - Country:US
Practice Address - Phone:804-828-7831
Practice Address - Fax:804-827-0002
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02022055891835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric