1174870695 NPI number — REHOBOTH PHARMACY INC

Table of content: (NPI 1174870695)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174870695 NPI number — REHOBOTH PHARMACY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REHOBOTH PHARMACY 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:
REHOBOTH PHARMACY INC
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:
1174870695
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2616 PHILADELPHIA PIKE STE B
Provider Second Line Business Mailing Address:
UNIT B
Provider Business Mailing Address City Name:
CLAYMONT
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19703-2520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-798-8900
Provider Business Mailing Address Fax Number:
302-798-8100

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2616 PHILADELPHIA PIKE STE B
Provider Second Line Business Practice Location Address:
UNIT B
Provider Business Practice Location Address City Name:
CLAYMONT
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19703-2520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-798-8900
Provider Business Practice Location Address Fax Number:
302-798-8100
Provider Enumeration Date:
08/14/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CHUKWUNENYE
Authorized Official First Name:
NWAKAEGO
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACY MANANGER
Authorized Official Telephone Number:
302-798-8900

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: A3-000952 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1174870695 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2136823 . This is a "PK" identifier . This identifiers is of the category "OTHER".