Healthcare Provider Details

I. General information

NPI: 1982288601
Provider Name (Legal Business Name): WILMINGTON VACCINES CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2021
Last Update Date: 08/08/2021
Certification Date: 08/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 N MADISON ST
WILMINGTON DE
19801-1439
US

IV. Provider business mailing address

915 N MADISON ST LOWR GROUND
WILMINGTON DE
19801-1439
US

V. Phone/Fax

Practice location:
  • Phone: 302-803-5978
  • Fax:
Mailing address:
  • Phone: 302-803-5978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1000X
TaxonomyMigrant Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID F AMAKOBE
Title or Position: DIRECTOR
Credential: DBA
Phone: 302-252-7279