Provider Demographics
NPI:1467493312
Name:DELAWARE PSYCHIATRIC CENTER PHARMACY
Entity Type:Organization
Organization Name:DELAWARE PSYCHIATRIC CENTER PHARMACY
Other - Org Name:DELAWARE PSYCHIATRIC CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUCKSHORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-255-9417
Mailing Address - Street 1:1901 N DUPONT HWY
Mailing Address - Street 2:SPRINGER BLDG ROOM 208
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-1100
Mailing Address - Country:US
Mailing Address - Phone:302-255-2793
Mailing Address - Fax:302-255-4420
Practice Address - Street 1:1901 N DUPONT HWY
Practice Address - Street 2:SPRINGER BUILDING ROOM 208
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-1100
Practice Address - Country:US
Practice Address - Phone:302-255-2793
Practice Address - Fax:302-255-4420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
DEA600002493336I0012X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2003069OtherPK
DE1000034053Medicaid