Provider Demographics
NPI:1710359187
Name:DELGARDO, ELISA (PHARMD)
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:
Last Name:DELGARDO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 VILLAGE GRN
Mailing Address - Street 2:
Mailing Address - City:BARDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:10954-2036
Mailing Address - Country:US
Mailing Address - Phone:917-699-2206
Mailing Address - Fax:
Practice Address - Street 1:41 VILLAGE GRN
Practice Address - Street 2:
Practice Address - City:BARDONIA
Practice Address - State:NY
Practice Address - Zip Code:10954-2036
Practice Address - Country:US
Practice Address - Phone:917-699-2206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049808183500000X
NJ28RI03195600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist