Provider Demographics
NPI:1073785283
Name:DELTA PHARMACY, INC.
Entity Type:Organization
Organization Name:DELTA PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:VALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-316-0055
Mailing Address - Street 1:P. O. BOX 65
Mailing Address - Street 2:
Mailing Address - City:ELSA
Mailing Address - State:TX
Mailing Address - Zip Code:78543
Mailing Address - Country:US
Mailing Address - Phone:956-316-0055
Mailing Address - Fax:956-383-1223
Practice Address - Street 1:103 S BROADWAY
Practice Address - Street 2:
Practice Address - City:ELSA
Practice Address - State:TX
Practice Address - Zip Code:78543-0065
Practice Address - Country:US
Practice Address - Phone:956-316-0055
Practice Address - Fax:956-383-1223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX057693336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0631960001Medicare NSC