Provider Demographics
NPI:1376930149
Name:DELTA HEALTH-THE MEDICAL CENTER
Entity Type:Organization
Organization Name:DELTA HEALTH-THE MEDICAL CENTER
Other - Org Name:DELTA HEALTH SPECIALTY PHARMACY
Other - Org Type:Other Name
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:662-725-2264
Mailing Address - Street 1:P.O. BOX 5247
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38704
Mailing Address - Country:US
Mailing Address - Phone:662-378-3783
Mailing Address - Fax:662-334-2424
Practice Address - Street 1:1400 E UNION ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38703-3246
Practice Address - Country:US
Practice Address - Phone:662-378-3783
Practice Address - Fax:662-334-2424
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DELTA HEALTH-THE MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-20
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
13785/2.03336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy