Provider Demographics
NPI:1558803239
Name:DELANEY PHARMACY LLC
Entity Type:Organization
Organization Name:DELANEY PHARMACY LLC
Other - Org Name:DELANEY PHARMACY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC/ MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:TUDOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-429-6944
Mailing Address - Street 1:2573 RICHMOND RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1700
Mailing Address - Country:US
Mailing Address - Phone:859-429-6944
Mailing Address - Fax:859-201-1439
Practice Address - Street 1:2573 RICHMOND RD STE 300
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1710
Practice Address - Country:US
Practice Address - Phone:859-429-6944
Practice Address - Fax:859-201-1439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-10
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
KYP078133336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2166279OtherPK