MEDICARE: DELTA DRUGS II, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0003X	Community/Retail Pharmacy	50204	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5637321	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1013233667
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DELTA DRUGS II, INC.

Provider Business Mailing Address
First Line	:	2497 E LAKESHORE DR
Second Line	:	UNIT B
City	:	LAKE ELSINORE
State	:	CA
Zip	:	92530-4437
Country	:	US
Telephone Number	:	951-245-2325
Fax Number	:	951-245-4295

Provider Business Practice Location Address
First Line	:	2497 E LAKESHORE DR STE B
Second Line	:
City	:	LAKE ELSINORE
State	:	CA
Zip	:	92530-4437
Country	:	US
Telephone Number	:	951-245-2325
Fax Number	:	951-245-4295

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RITA AVAKIAN
Credential	:
Telephone Number	:	951-245-2325

Provider Enumeration Date	:	04/07/2010
Last Update Date	:	04/07/2010

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