Healthcare Provider Details

I. General information

NPI: 1497776330
Provider Name (Legal Business Name): DELPRETE'S PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3437 ROUTE 309
OREFIELD PA
18069-2419
US

IV. Provider business mailing address

3437 ROUTE 309
OREFIELD PA
18069-2419
US

V. Phone/Fax

Practice location:
  • Phone: 610-395-2602
  • Fax: 610-395-2740
Mailing address:
  • Phone: 610-395-2602
  • Fax: 610-395-2740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP414680L
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier1304412
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: KEITH ANTHONY DELPRETE
Title or Position: PHARMACIST/OWNER
Credential: PHARMCIST RP030573L
Phone: 610-395-2602