Provider Demographics
NPI:1851768246
Name:DELANCY, LISA JONAY ROWE
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:JONAY ROWE
Last Name:DELANCY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 CAESAR WAY S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33712-4220
Mailing Address - Country:US
Mailing Address - Phone:727-642-4978
Mailing Address - Fax:
Practice Address - Street 1:1818 CAESAR WAY S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33712-4220
Practice Address - Country:US
Practice Address - Phone:727-642-4978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL33632183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist