Provider Demographics
NPI:1831790484
Name:DELOIA, ANTHONY (RPH)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:DELOIA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:ANTHONY
Other - Middle Name:
Other - Last Name:DELOIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:20 INDUSTRIAL DR
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-3842
Mailing Address - Country:US
Mailing Address - Phone:814-375-5005
Mailing Address - Fax:
Practice Address - Street 1:20 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-3842
Practice Address - Country:US
Practice Address - Phone:814-375-5005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP029448L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1PX2-W12-DQ00Medicaid