Provider Demographics
NPI:1205182870
Name:DELAIRE PHARMACY LLC
Entity Type:Organization
Organization Name:DELAIRE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/STORE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NGOC
Authorized Official - Middle Name:T
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-343-8741
Mailing Address - Street 1:9456 STATE RD STORE #13
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-3079
Mailing Address - Country:US
Mailing Address - Phone:267-343-8742
Mailing Address - Fax:267-343-8798
Practice Address - Street 1:9456 STATE RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-3079
Practice Address - Country:US
Practice Address - Phone:267-343-8741
Practice Address - Fax:267-343-8798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-31
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy