Provider Demographics
NPI:1235184060
Name:BI STATE PHARMACY INC
Entity Type:Organization
Organization Name:BI STATE PHARMACY INC
Other - Org Name:BI STATE PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ASARE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:302-846-9101
Mailing Address - Street 1:PO BOX 265
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:DE
Mailing Address - Zip Code:19940-0265
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5 E STATE ST
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:DE
Practice Address - Zip Code:19940-1154
Practice Address - Country:US
Practice Address - Phone:302-846-9101
Practice Address - Fax:302-846-9696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA300009343336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000039669Medicaid
0844779OtherNCPDP PROVIDER IDENTIFICATION NUMBER