MEDICARE: DELVIN 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	3336C0003X	Community/Retail Pharmacy	017800	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3376919	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265551840
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DELVIN PHARMACY INC

Provider Business Mailing Address
First Line	:	32 24 STEINWAY ST
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11103-4006
Country	:	US
Telephone Number	:	718-204-7867
Fax Number	:	718-204-5936

Provider Business Practice Location Address
First Line	:	32 24 STEINWAY ST
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11103-4006
Country	:	US
Telephone Number	:	718-204-7867
Fax Number	:	718-204-5936

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JULIO DELERME
Credential	:	RPH
Telephone Number	:	718-204-7867

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	03/30/2012

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