Healthcare Provider Details

I. General information

NPI: 1851438527
Provider Name (Legal Business Name): DELTONA MEDICAL ARTS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 09/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 TOWN CENTER DR STE 100
ORANGE CITY FL
32763-8266
US

IV. Provider business mailing address

921 TOWN CENTER DR SUITE 100
ORANGE CITY FL
32763-8311
US

V. Phone/Fax

Practice location:
  • Phone: 386-774-7933
  • Fax: 386-774-7944
Mailing address:
  • Phone: 386-774-7933
  • Fax: 386-774-7944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
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 NumberPH10785
License Number StateFL

VIII. Authorized Official

Name: MUKESH AMIN
Title or Position: PRESIDENT
Credential: PHARMACIST
Phone: 386-774-7933