Provider Demographics
NPI:1508484148
Name:DELELLO, NICOLE R (PHARMD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:R
Last Name:DELELLO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:R
Other - Last Name:DELELLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:187 STATE ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-1803
Mailing Address - Country:US
Mailing Address - Phone:315-255-0014
Mailing Address - Fax:315-255-1947
Practice Address - Street 1:187 STATE ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-1803
Practice Address - Country:US
Practice Address - Phone:315-255-0014
Practice Address - Fax:315-255-1947
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-09
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY065189183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist