Provider Demographics
NPI:1598157091
Name:CANTERBURY, DELON (DR)
Entity Type:Individual
Prefix:
First Name:DELON
Middle Name:
Last Name:CANTERBURY
Suffix:
Gender:M
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 S ESTES DR APT 71
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-7000
Mailing Address - Country:US
Mailing Address - Phone:404-484-5092
Mailing Address - Fax:
Practice Address - Street 1:3601 ROGERS RD
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-7634
Practice Address - Country:US
Practice Address - Phone:919-453-0932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-21
Last Update Date:2015-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24832183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist