Provider Demographics
NPI:1336124007
Name:DALPHARM INC
Entity Type:Organization
Organization Name:DALPHARM INC
Other - Org Name:DALTON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MAYUR
Authorized Official - Middle Name:C
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:570-563-1151
Mailing Address - Street 1:102 W MAIN ST
Mailing Address - Street 2:P.O.BOX 27
Mailing Address - City:DALTON
Mailing Address - State:PA
Mailing Address - Zip Code:18414-0027
Mailing Address - Country:US
Mailing Address - Phone:570-563-1151
Mailing Address - Fax:570-563-0138
Practice Address - Street 1:102 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:PA
Practice Address - Zip Code:18414
Practice Address - Country:US
Practice Address - Phone:570-563-1151
Practice Address - Fax:570-563-0138
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DALPHARM INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-12-14
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP039137L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014469640001Medicaid
PA0014469640001Medicaid