Individual
ANTHONY DEGELORM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
301 E MAIN ST, BAY SHORE, NY 11706-8408
(631) 675-4201
Mailing address
25 PATRICK CIR, FULTON, NY 13069-3209
(315) 561-1239
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
064729
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
064729
NEW YORK STATE BOARD OF PHARMACY
NY
Enumeration date
10/15/2018
Last updated
10/15/2018
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