MEDICARE: REHOBOTH PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0004X	Compounding Pharmacy
3	3336C0003X	Community/Retail Pharmacy	A3-000952	DE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2136823	OTHER		PK

General Provider Information

NPI Number	:	1174870695
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REHOBOTH PHARMACY INC

Provider Business Mailing Address
First Line	:	2616 PHILADELPHIA PIKE STE B
Second Line	:	UNIT B
City	:	CLAYMONT
State	:	DE
Zip	:	19703-2520
Country	:	US
Telephone Number	:	302-798-8900
Fax Number	:	302-798-8100

Provider Business Practice Location Address
First Line	:	2616 PHILADELPHIA PIKE STE B
Second Line	:	UNIT B
City	:	CLAYMONT
State	:	DE
Zip	:	19703-2520
Country	:	US
Telephone Number	:	302-798-8900
Fax Number	:	302-798-8100

Authorized Official
Title or Position	:	PHARMACY MANANGER
Name	:	NWAKAEGO CHUKWUNENYE
Credential	:	MBA, PHARMD
Telephone Number	:	302-798-8900

Provider Enumeration Date	:	08/14/2012
Last Update Date	:	07/19/2018

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Directions to “REHOBOTH PHARMACY INC ” Practice Location

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