Provider Demographics
NPI:1275109027
Name:DELTA HEALTH SYSTEM
Entity Type:Organization
Organization Name:DELTA HEALTH SYSTEM
Other - Org Name:DELTA HEALTH-NORTHWEST REGIONAL (SPECIALTY PHARMACY)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:IRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:STACKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-725-2020
Mailing Address - Street 1:1970 HOSPITAL DR STE 1
Mailing Address - Street 2:
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-7202
Mailing Address - Country:US
Mailing Address - Phone:662-627-3211
Mailing Address - Fax:
Practice Address - Street 1:1970 HOSPITAL DR STE 1
Practice Address - Street 2:
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-7202
Practice Address - Country:US
Practice Address - Phone:662-624-3165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DELTA HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-02
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy