Provider Demographics
NPI:1831794551
Name:DELPHONSE, MAX EDENS (PHARMD)
Entity type:Individual
Prefix:
First Name:MAX
Middle Name:EDENS
Last Name:DELPHONSE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2962 NE 199TH ST
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-3103
Mailing Address - Country:US
Mailing Address - Phone:305-692-2499
Mailing Address - Fax:
Practice Address - Street 1:2962 NE 199TH ST
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-3103
Practice Address - Country:US
Practice Address - Phone:305-692-2499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS60972183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty