Provider Demographics
NPI:1144825019
Name:DELONJAY, MICHAEL (RPH)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:DELONJAY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:DELONJAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:4249 OUTER LOOP
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-3850
Mailing Address - Country:US
Mailing Address - Phone:502-968-3618
Mailing Address - Fax:
Practice Address - Street 1:4249 OUTER LOOP
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-3850
Practice Address - Country:US
Practice Address - Phone:502-968-3618
Practice Address - Fax:502-966-0162
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9369183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist