Provider Demographics
NPI:1386830859
Name:THE NEMOURS FOUNDATION
Entity Type:Organization
Organization Name:THE NEMOURS FOUNDATION
Other - Org Name:NEMOURS CHILDRENS HOSPITAL COMMUNITY PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:VP, FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCKENDREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-697-5628
Mailing Address - Street 1:PO BOX 404112
Mailing Address - Street 2:C/O MANAGED CARE
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-4112
Mailing Address - Country:US
Mailing Address - Phone:904-390-3610
Mailing Address - Fax:904-697-5630
Practice Address - Street 1:1600 ROCKLAND RD
Practice Address - Street 2:OUTPATIENT PHARMACY
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3607
Practice Address - Country:US
Practice Address - Phone:302-651-4000
Practice Address - Fax:302-651-4945
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE NEMOURS FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-19
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE138975333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1007434570014Medicaid
DE080-1351OtherNABP