Provider Demographics
NPI:1982162137
Name:CHILDERS-DAMIAN, DELANEY C (PHARMD)
Entity type:Individual
Prefix:
First Name:DELANEY
Middle Name:C
Last Name:CHILDERS-DAMIAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:DELANEY
Other - Middle Name:C
Other - Last Name:CHILDERS-DAMIAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:7160 INDUSTRIAL ROW DR
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-1398
Mailing Address - Country:US
Mailing Address - Phone:513-557-7650
Mailing Address - Fax:
Practice Address - Street 1:7160 INDUSTRIAL ROW DR
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-1398
Practice Address - Country:US
Practice Address - Phone:513-557-7650
Practice Address - Fax:513-557-7675
Is Sole Proprietor?:No
Enumeration Date:2019-03-06
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03338046183500000X
IN26028053A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH03338046OtherLICENSE