Healthcare Provider Details

I. General information

NPI: 1427688316
Provider Name (Legal Business Name): DELTA MEDICAL PHARMACY ANTIOCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2020
Last Update Date: 01/21/2020
Certification Date: 01/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1888 A ST
ANTIOCH CA
94509-2602
US

IV. Provider business mailing address

1307 CARLISLE CT
BRENTWOOD CA
94513-1761
US

V. Phone/Fax

Practice location:
  • Phone: 925-695-6987
  • Fax:
Mailing address:
  • Phone: 925-695-6987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. JATIN KIRTIKUMAR MEHTA
Title or Position: DIRECTOR
Credential:
Phone: 925-695-6987