Provider Demographics
NPI:1083761134
Name:FAMILY PHARMACY INC
Entity Type:Organization
Organization Name:FAMILY PHARMACY INC
Other - Org Name:FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RPH
Authorized Official - Prefix:
Authorized Official - First Name:IFEANYI
Authorized Official - Middle Name:
Authorized Official - Last Name:MMAGU
Authorized Official - Suffix:
Authorized Official - Credentials:PHRMD
Authorized Official - Phone:302-652-1994
Mailing Address - Street 1:PO BOX 30410
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-7410
Mailing Address - Country:US
Mailing Address - Phone:302-652-1994
Mailing Address - Fax:302-652-6960
Practice Address - Street 1:1416 LANCASTER AVE
Practice Address - Street 2:BAYARD SQUARE
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-3905
Practice Address - Country:US
Practice Address - Phone:302-652-1994
Practice Address - Fax:302-652-6960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
DEA3-00005863336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000572107Medicaid
2003729OtherPK
2003729OtherPK