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General NPI Number Information
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NPI Number | 1730389271
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Entity Type | Organization
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Legal Business Name | DALEO COMPOUNDING PHARMACY
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Dates
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Enumeration Date | 07/23/2007
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Last Update Date | 07/23/2007
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Provider Practice Location Address
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Address Line | 2400 CALDER AVE.
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City | BEAUMONT
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State | TX
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Zip | 77702
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Country | US
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Telephone | 409-833-2211
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Fax | 409-833-8549
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Provider Business Mailing Address
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Address Line | 2400 CALDER AVE.
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City | BEAUMONT
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State | TX
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Zip | 77702
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Country | US
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Telephone | 409-833-2211
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Fax | 409-833-8549
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | CHARLES J DALEO
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Credential | RPH
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Telephone | 409-833-2211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | 10403
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License Number State | TX
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