Healthcare Provider Details

I. General information

NPI: 1083761134
Provider Name (Legal Business Name): FAMILY PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 10/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1416 LANCASTER AVE BAYARD SQUARE
WILMINGTON DE
19805-3905
US

IV. Provider business mailing address

PO BOX 30410
WILMINGTON DE
19805-7410
US

V. Phone/Fax

Practice location:
  • Phone: 302-652-1994
  • Fax: 302-652-6960
Mailing address:
  • Phone: 302-652-1994
  • Fax: 302-652-6960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberA3-0000586
License Number StateDE

VIII. Authorized Official

Name: IFEANYI MMAGU
Title or Position: RPH
Credential: PHRMD
Phone: 302-652-1994