Provider Demographics
NPI:1225183460
Name:1934 DELMAR PHARMACY INCORPORATED
Entity Type:Organization
Organization Name:1934 DELMAR PHARMACY INCORPORATED
Other - Org Name:DELMAR PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:484-494-8899
Mailing Address - Street 1:1934 DELMAR DRIVE
Mailing Address - Street 2:
Mailing Address - City:FOLCROFT
Mailing Address - State:PA
Mailing Address - Zip Code:19032
Mailing Address - Country:US
Mailing Address - Phone:484-494-8899
Mailing Address - Fax:484-494-5817
Practice Address - Street 1:1934 DELMAR
Practice Address - Street 2:PHARMACY
Practice Address - City:FOLCROFT
Practice Address - State:PA
Practice Address - Zip Code:19032
Practice Address - Country:US
Practice Address - Phone:484-494-8899
Practice Address - Fax:484-494-5817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4813963336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1013103880001Medicaid
PP481396OtherPA LIC
PAF90528022OtherDEA
PP481396OtherPA LIC