Provider Demographics
NPI:1689099863
Name:PAUL DELGADO, ANDREEA-MARIA (RPH)
Entity Type:Individual
Prefix:
First Name:ANDREEA-MARIA
Middle Name:
Last Name:PAUL DELGADO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:ANDREEA
Other - Middle Name:MARIA
Other - Last Name:PAUL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MAIDEN NAME
Mailing Address - Street 1:75 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-3634
Mailing Address - Country:US
Mailing Address - Phone:561-729-2900
Mailing Address - Fax:
Practice Address - Street 1:2094 LINDEN BLVD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-7412
Practice Address - Country:US
Practice Address - Phone:347-770-8633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-25
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03621100183500000X
NY059320183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist