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General NPI Number Information
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NPI Number | 1073785283
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Entity Type | Organization
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Legal Business Name | DELTA PHARMACY, INC.
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Dates
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Enumeration Date | 03/27/2008
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Last Update Date | 04/07/2008
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Provider Practice Location Address
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Address Line | 103 S BROADWAY
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City | ELSA
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State | TX
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Zip | 78543-0065
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Country | US
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Telephone | 956-316-0055
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Fax | 956-383-1223
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Provider Business Mailing Address
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Address Line | P. O. BOX 65
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City | ELSA
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State | TX
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Zip | 78543
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Country | US
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Telephone | 956-316-0055
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Fax | 956-383-1223
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Authorized Official
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Title or Position | PRESIDENT/PRESIDENT
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Name | JOSE JOEL VALE
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Credential |
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Telephone | 956-316-0055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 05769
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License Number State | TX
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