Provider Demographics
NPI:1013500560
Name:DELIA, SUSAN K (RPH)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:K
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 1:407 LINDGREN LN
Mailing Address - Street 2:
Mailing Address - City:BELVIDERE
Mailing Address - State:IL
Mailing Address - Zip Code:61008-7065
Mailing Address - Country:US
Mailing Address - Phone:815-494-5743
Mailing Address - Fax:815-765-2328
Practice Address - Street 1:407 LINDGREN LN
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:IL
Practice Address - Zip Code:61008-7065
Practice Address - Country:US
Practice Address - Phone:815-494-5743
Practice Address - Fax:815-765-2328
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-035421183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist