1336124007 NPI number — DALPHARM INC

Table of content: (NPI 1336124007)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336124007 NPI number — DALPHARM INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DALPHARM INC
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:
DALTON 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:
1336124007
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 W MAIN ST
Provider Second Line Business Mailing Address:
P.O.BOX 27
Provider Business Mailing Address City Name:
DALTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18414-0027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-563-1151
Provider Business Mailing Address Fax Number:
570-563-0138

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-563-1151
Provider Business Practice Location Address Fax Number:
570-563-0138
Provider Enumeration Date:
12/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
MAYUR
Authorized Official Middle Name:
C
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
570-563-1151

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  RP039137L , 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: 0014469640001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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