Provider Demographics
NPI:1962603050
Name:DELP, BRIAN MATTHEW
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:MATTHEW
Last Name:DELP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 WEDGEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33566-0923
Mailing Address - Country:US
Mailing Address - Phone:813-759-2617
Mailing Address - Fax:813-759-2617
Practice Address - Street 1:2602 JAMES L REDMAN PKWY
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33566-9460
Practice Address - Country:US
Practice Address - Phone:813-752-5765
Practice Address - Fax:813-754-1179
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS29431183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS29431OtherSTATE LICENSE NUMBER