Healthcare Provider Details

I. General information

NPI: 1013577253
Provider Name (Legal Business Name): DELRAY PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2019
Last Update Date: 06/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5130 LINTON BLVD STE F6
DELRAY BEACH FL
33484-6597
US

IV. Provider business mailing address

5130 LINTON BLVD STE F6
DELRAY BEACH FL
33484-6597
US

V. Phone/Fax

Practice location:
  • Phone: 561-455-2309
  • Fax:
Mailing address:
  • Phone: 561-455-2309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. NENEL BRISK
Title or Position: OWNER/PHARMACIST IN CHARGE
Credential: PHARMD
Phone: 561-455-2309