Provider Demographics
NPI:1629384979
Name:DELUXE DRUG STORES LLC
Entity Type:Organization
Organization Name:DELUXE DRUG STORES LLC
Other - Org Name:DELUXE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:VENKATA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALAMURI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-941-7689
Mailing Address - Street 1:8749 FRANKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19136-2126
Mailing Address - Country:US
Mailing Address - Phone:215-941-7689
Mailing Address - Fax:215-941-7893
Practice Address - Street 1:8749 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19136-2126
Practice Address - Country:US
Practice Address - Phone:215-941-7689
Practice Address - Fax:215-941-7893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-24
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4820513336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025140600001Medicaid
3994337OtherNCPDP PROVIDER IDENTIFICATION NUMBER
3994337OtherNCPDP PROVIDER IDENTIFICATION NUMBER