Provider Demographics
NPI:1760587406
Name:DELINCK, PETER WILLIAM (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:WILLIAM
Last Name:DELINCK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10716 MARTINIQUE LN
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-9448
Mailing Address - Country:US
Mailing Address - Phone:219-663-4414
Mailing Address - Fax:
Practice Address - Street 1:9330 BROADWAY
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-8602
Practice Address - Country:US
Practice Address - Phone:219-662-5093
Practice Address - Fax:219-662-5178
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26019848A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist