1225183460 NPI number — 1934 DELMAR PHARMACY INCORPORATED

Table of content: (NPI 1225183460)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225183460 NPI number — 1934 DELMAR PHARMACY INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
1934 DELMAR PHARMACY INCORPORATED
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DELMAR PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225183460
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1934 DELMAR DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOLCROFT
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-494-8899
Provider Business Mailing Address Fax Number:
484-494-5817

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1934 DELMAR
Provider Second Line Business Practice Location Address:
PHARMACY
Provider Business Practice Location Address City Name:
FOLCROFT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-494-8899
Provider Business Practice Location Address Fax Number:
484-494-5817
Provider Enumeration Date:
01/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WALKER
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
484-494-8899

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PP481396 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1013103880001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: PP481396 . This is a "PA LIC" identifier . This identifiers is of the category "OTHER".




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