Healthcare Provider Details

I. General information

NPI: 1902939416
Provider Name (Legal Business Name): DELCO DRUGS AND SPECIALTY PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 10/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3833 RICHMOND AVE
STATEN ISLAND NY
10312-3828
US

IV. Provider business mailing address

3833 RICHMOND AVE
STATEN ISLAND NY
10312-3828
US

V. Phone/Fax

Practice location:
  • Phone: 718-984-6600
  • Fax: 718-984-6601
Mailing address:
  • Phone: 718-984-6600
  • Fax: 718-984-6601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number028979
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ROBERT ANNICHARICO
Title or Position: OWNER
Credential: BS PHARMACY
Phone: 718-984-6600