Provider Demographics
NPI:1124008081
Name:DALECO, INC.
Entity Type:Organization
Organization Name:DALECO, INC.
Other - Org Name:USA DRUG #7638
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ST EPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAFRANCE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:870-850-8312
Mailing Address - Street 1:120 E. KARSCH BLVD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640
Mailing Address - Country:US
Mailing Address - Phone:573-747-2104
Mailing Address - Fax:573-756-4525
Practice Address - Street 1:1142 N DESLOGE DR
Practice Address - Street 2:
Practice Address - City:DESLOGE
Practice Address - State:MO
Practice Address - Zip Code:63601-2937
Practice Address - Country:US
Practice Address - Phone:573-431-2242
Practice Address - Fax:573-431-4799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003019224332B00000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO4865760002Medicare NSC