Provider Demographics
NPI:1639281637
Name:DELTA PHARMACY
Entity Type:Organization
Organization Name:DELTA PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HEENEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-282-8298
Mailing Address - Street 1:108 COMMERCE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-2736
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:108 COMMERCE AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-2736
Practice Address - Country:US
Practice Address - Phone:662-846-6560
Practice Address - Fax:662-546-6592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS069290113336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2586672OtherOTHER ID NUMBER
2586672OtherOTHER ID NUMBER-COMMERCIAL NUMBER