Provider Demographics
NPI:1801439856
Name:D'ELIA, LEIDY GUADALUPE (RPH)
Entity type:Individual
Prefix:
First Name:LEIDY
Middle Name:GUADALUPE
Last Name:D'ELIA
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 1:14954 SW 9TH WAY
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33194-2595
Mailing Address - Country:US
Mailing Address - Phone:786-541-7374
Mailing Address - Fax:
Practice Address - Street 1:6991 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4743
Practice Address - Country:US
Practice Address - Phone:786-257-4095
Practice Address - Fax:786-257-4096
Is Sole Proprietor?:No
Enumeration Date:2019-10-22
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS52429183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist