Healthcare Provider Details

I. General information

NPI: 1104127851
Provider Name (Legal Business Name): PHYSICIAN DISPENSING SOLUTIONS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2010
Last Update Date: 11/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 BEISER BLVD SUITE 201F
DOVER DE
19904-8208
US

IV. Provider business mailing address

240 BEISER BLVD SUITE 201F
DOVER DE
19904-8208
US

V. Phone/Fax

Practice location:
  • Phone: 302-734-7246
  • Fax: 302-678-8890
Mailing address:
  • Phone: 302-734-7246
  • Fax: 302-678-8890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License NumberDEA BB6016403
License Number StateDE

VIII. Authorized Official

Name: GANESH R BALU
Title or Position: PRESIDENT
Credential: MD
Phone: 302-734-7246