Provider Demographics
NPI:1497377766
Name:DELAPAZ, BRYAN KRISTOFFER (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:KRISTOFFER
Last Name:DELAPAZ
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14821 SIX MILE CYPRESS PKWY
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4467
Mailing Address - Country:US
Mailing Address - Phone:239-433-7744
Mailing Address - Fax:
Practice Address - Street 1:14821 SIX MILE CYPRESS PKWY
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4467
Practice Address - Country:US
Practice Address - Phone:239-433-7744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-10
Last Update Date:2020-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS59781183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist