Provider Demographics
NPI:1437495371
Name:PPMI INC
Entity Type:Organization
Organization Name:PPMI INC
Other - Org Name:MILLER ROAD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZZOTTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-584-1972
Mailing Address - Street 1:3610 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19802-2524
Mailing Address - Country:US
Mailing Address - Phone:302-764-5348
Mailing Address - Fax:302-764-5349
Practice Address - Street 1:3610 MILLER RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19802-2524
Practice Address - Country:US
Practice Address - Phone:302-764-5348
Practice Address - Fax:302-764-5349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-21
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE7151150001Medicare NSC