Healthcare Provider Details

I. General information

NPI: 1912086687
Provider Name (Legal Business Name): DELRAY SHORES PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 NE 5TH AVE
DELRAY BEACH FL
33483
US

IV. Provider business mailing address

124 NE 5TH AVE
DELRAY BEACH FL
33483-5429
US

V. Phone/Fax

Practice location:
  • Phone: 561-272-2124
  • Fax: 561-272-2830
Mailing address:
  • Phone: 561-272-2124
  • Fax: 561-272-2830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH6174
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: THOMAS DILDINE
Title or Position: PRESIDENT, PIC
Credential: PHARMD
Phone: 561-272-2124