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General NPI Number Information
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NPI Number | 1205182870
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Entity Type | Organization
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Legal Business Name | DELAIRE PHARMACY LLC
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Dates
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Enumeration Date | 07/31/2012
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Last Update Date | 09/19/2013
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Provider Practice Location Address
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Address Line | 9456 STATE RD
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City | PHILADELPHIA
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State | PA
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Zip | 19114-3079
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Country | US
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Telephone | 267-343-8741
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Fax | 267-343-8798
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Provider Business Mailing Address
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Address Line | 9456 STATE RD STORE #13
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City | PHILADELPHIA
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State | PA
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Zip | 19114-3079
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Country | US
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Telephone | 267-343-8742
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Fax | 267-343-8798
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Authorized Official
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Title or Position | PHARMACIST/STORE MANAGER
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Name | MRS. NGOC T CHUNG
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Credential |
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Telephone | 267-343-8741
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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 |
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License Number State |
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