Provider Demographics
NPI:1790093318
Name:DEFILIPPIS, ANTHONY KENNETH (RPH)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:KENNETH
Last Name:DEFILIPPIS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 N NORWOOD ST
Mailing Address - Street 2:
Mailing Address - City:WALLACE
Mailing Address - State:NC
Mailing Address - Zip Code:28466-1334
Mailing Address - Country:US
Mailing Address - Phone:910-285-5787
Mailing Address - Fax:
Practice Address - Street 1:1224 N NORWOOD ST
Practice Address - Street 2:
Practice Address - City:WALLACE
Practice Address - State:NC
Practice Address - Zip Code:28466-1334
Practice Address - Country:US
Practice Address - Phone:910-285-5787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20927183500000X
NJRI01530400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist