Provider Demographics
NPI:1942587035
Name:DELIA, KATHRYN LYN (RPH)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:LYN
Last Name:DELIA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 KELSEYTOWN RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:CT
Mailing Address - Zip Code:06413-1248
Mailing Address - Country:US
Mailing Address - Phone:860-669-5444
Mailing Address - Fax:203-488-3126
Practice Address - Street 1:329 EAST MAIN ST
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405
Practice Address - Country:US
Practice Address - Phone:203-481-0386
Practice Address - Fax:203-488-3126
Is Sole Proprietor?:No
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5651183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist