Provider Demographics
NPI:1134791254
Name:DEFILIPPO, NICHOLAS ANGELO (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:ANGELO
Last Name:DEFILIPPO
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 PARK ST APT 14U
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5464
Mailing Address - Country:US
Mailing Address - Phone:609-475-2753
Mailing Address - Fax:
Practice Address - Street 1:55 PARK STREET
Practice Address - Street 2:DEPARTMENT OF PHARMACY SERVICES
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510
Practice Address - Country:US
Practice Address - Phone:203-688-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-16
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.00156871835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Multi-Specialty