Provider Demographics
NPI:1730784620
Name:DERIGE, DELIA Z (RPH)
Entity type:Individual
Prefix:
First Name:DELIA
Middle Name:Z
Last Name:DERIGE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7120 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-6938
Mailing Address - Country:US
Mailing Address - Phone:727-848-3442
Mailing Address - Fax:727-843-8092
Practice Address - Street 1:7120 RIDGE RD
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-6938
Practice Address - Country:US
Practice Address - Phone:727-848-3442
Practice Address - Fax:727-843-9092
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
FLPS24806183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS24806OtherFLORIDA BOARD OF PHARMACY