Provider Demographics
NPI:1306145594
Name:DELIA, AMY E (RPH)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:E
Last Name:DELIA
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 1:2009 NE HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-4564
Mailing Address - Country:US
Mailing Address - Phone:360-953-0190
Mailing Address - Fax:
Practice Address - Street 1:808 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-9136
Practice Address - Country:US
Practice Address - Phone:360-687-5186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60112490183500000X
MO2009011858183500000X
ORRPH-0013976183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist