Healthcare Provider Details

I. General information

NPI: 1235184060
Provider Name (Legal Business Name): BI STATE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 10/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 E STATE ST
DELMAR DE
19940-1154
US

IV. Provider business mailing address

PO BOX 265
DELMAR DE
19940-0265
US

V. Phone/Fax

Practice location:
  • Phone: 302-846-9101
  • Fax: 302-846-9696
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberA30000934
License Number StateDE

VIII. Authorized Official

Name: EDWARD ASARE
Title or Position: OWNER
Credential: RPH
Phone: 302-846-9101