Provider Demographics
NPI:1063905909
Name:DELLARIPA, PETER ANTHONY (RPH)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:ANTHONY
Last Name:DELLARIPA
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 1:232 GREAT POND RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06073-3102
Mailing Address - Country:US
Mailing Address - Phone:860-633-7306
Mailing Address - Fax:
Practice Address - Street 1:940 SILVER LN
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06118-1235
Practice Address - Country:US
Practice Address - Phone:860-569-7135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5368183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty