Provider Demographics
NPI:1972237253
Name:DELGRECO, ANTHONY M (RPH)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:M
Last Name:DELGRECO
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 1:1530 PALISADE AVE APT 14N
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-5422
Mailing Address - Country:US
Mailing Address - Phone:201-707-5368
Mailing Address - Fax:
Practice Address - Street 1:16 E PROSPECT ST
Practice Address - Street 2:
Practice Address - City:WALDWICK
Practice Address - State:NJ
Practice Address - Zip Code:07463-2098
Practice Address - Country:US
Practice Address - Phone:201-445-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0003677183500000X
NJ28RI01136400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist