Healthcare Provider Details

I. General information

NPI: 1336713064
Provider Name (Legal Business Name): CHESAPEAKE REGIONAL PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 CENTURY BLVD
WILMINGTON DE
19808-6271
US

IV. Provider business mailing address

470 CENTURY BLVD
WILMINGTON DE
19808-6271
US

V. Phone/Fax

Practice location:
  • Phone: 845-559-7607
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KINJAL PATEL
Title or Position: MEMBER
Credential:
Phone: 845-559-7607