Basic Information
| Provider Information | |||||||||
| NPI: | 1144747197 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DELEONARDO | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | ANDREW | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 485 ARSENAL ST | ||||||||
| Address2: | |||||||||
| City: | WATERTOWN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024725091 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6179725381 | ||||||||
| FaxNumber: | 6179725326 | ||||||||
| Practice Location | |||||||||
| Address1: | 485 ARSENAL ST | ||||||||
| Address2: | |||||||||
| City: | WATERTOWN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024725091 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6179725381 | ||||||||
| FaxNumber: | 6179725326 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2017 | ||||||||
| LastUpdateDate: | 02/22/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PR46787 | ME | N | Pharmacy Service Providers | Pharmacist | 183500000X | PH238594 | MA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.