Healthcare Provider Details

I. General information

NPI: 1134179435
Provider Name (Legal Business Name): DEBALKO'S PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 S HANCOCK ST
MCADOO PA
18237-1608
US

IV. Provider business mailing address

322 S HANCOCK ST
MCADOO PA
18237-1608
US

V. Phone/Fax

Practice location:
  • Phone: 570-929-1130
  • Fax: 570-929-1208
Mailing address:
  • Phone: 570-929-1130
  • Fax: 570-929-1208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberPP412373L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License NumberPP412373L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPP412373L
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP412373L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier39HI25
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerCAPITAL BLUE CROSS IV
# 2
Identifier39HA85
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerCAPITAL BLUE CROSS DME
# 3
Identifier996009
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerNEPA BC IV PROVIDER
# 4
IdentifierPP412373L
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerPHARMACY LICENSE NUMBER
# 5
Identifier001017817
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 6
Identifier075861
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerIST PRIORITY IV PROVIDER
# 7
Identifier237105
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerBLUE SHIELD IV

VIII. Authorized Official

Name: DR. JOHN NICHOLAS DEBALKO
Title or Position: PRESIDENT
Credential: RPH, PHARMD
Phone: 570-929-2028