Healthcare Provider Details

I. General information

NPI: 1629076377
Provider Name (Legal Business Name): DALECO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 08/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 WEBER RD
FARMINGTON MO
63640-3352
US

IV. Provider business mailing address

1401 S BOULDER AVE STE 300
TULSA OK
74119-3647
US

V. Phone/Fax

Practice location:
  • Phone: 573-756-6117
  • Fax: 573-756-5541
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2008035866
License Number StateMO

VIII. Authorized Official

Name: GALEN PERKINS
Title or Position: PHARMACY SERVICES COORDINATOR
Credential:
Phone: 501-296-3311