Provider Demographics
NPI:1215252747
Name:DEPALO, MAURICE F (RPH)
Entity type:Individual
Prefix:MR
First Name:MAURICE
Middle Name:F
Last Name:DEPALO
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 1:2730 E TREMONT AVE
Mailing Address - Street 2:2475 ST. RAYMONDS AVE
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2808
Mailing Address - Country:US
Mailing Address - Phone:718-597-5230
Mailing Address - Fax:
Practice Address - Street 1:2730 E TREMONT AVE
Practice Address - Street 2:2475 ST. RAYMONDS AVE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2808
Practice Address - Country:US
Practice Address - Phone:718-597-5230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-27
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034045183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist