Provider Demographics
NPI:1477867448
Name:DERBYSHIRE, DEAN EDGAR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:EDGAR
Last Name:DERBYSHIRE
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 1:4751 ONONDAGA BLVD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13219-3315
Mailing Address - Country:US
Mailing Address - Phone:315-380-2701
Mailing Address - Fax:
Practice Address - Street 1:4751 ONONDAGA BLVD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13219-3315
Practice Address - Country:US
Practice Address - Phone:315-380-2701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-02
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054672183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist