Provider Demographics
NPI:1518912427
Name:NEW CASTLE COMMUNITY MENTAL HEALTH PHARMACY
Entity Type:Organization
Organization Name:NEW CASTLE COMMUNITY MENTAL HEALTH PHARMACY
Other - Org Name:NEW CASTLE COMMUNITY MENTAL HEALTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICALDIRECTOR/DIRECTOR OF GERIATR
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-255-2838
Mailing Address - Street 1:1936A MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805
Mailing Address - Country:US
Mailing Address - Phone:302-778-6950
Mailing Address - Fax:302-622-4178
Practice Address - Street 1:1936A MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805
Practice Address - Country:US
Practice Address - Phone:302-778-6950
Practice Address - Fax:302-622-4178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
183500000X, 183700000X, 3336C0003X
DEA30000638183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
No183700000XPharmacy Service ProvidersPharmacy TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000255407Medicaid