Provider Demographics
NPI:1932428927
Name:DELA CRUZ, JEROME (RPH)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:
Last Name:DELA CRUZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 DR MARTIN LUTHER KING JUNIOR PKWY
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-4422
Mailing Address - Country:US
Mailing Address - Phone:530-413-3017
Mailing Address - Fax:
Practice Address - Street 1:2100 DR MARTIN LUTHER KING JUNIOR PKWY
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-4422
Practice Address - Country:US
Practice Address - Phone:530-342-8892
Practice Address - Fax:530-342-3658
Is Sole Proprietor?:No
Enumeration Date:2010-05-31
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25130183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist