Provider Demographics
NPI:1659666956
Name:DELISLE, JAY (PHARM D)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:
Last Name:DELISLE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MASSENA
Mailing Address - State:NY
Mailing Address - Zip Code:13662-1972
Mailing Address - Country:US
Mailing Address - Phone:315-769-3484
Mailing Address - Fax:
Practice Address - Street 1:26 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:MASSENA
Practice Address - State:NY
Practice Address - Zip Code:13662-1744
Practice Address - Country:US
Practice Address - Phone:315-705-4254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050975183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist