Provider Demographics
NPI:1639359284
Name:DELTA DRUGS II INC
Entity Type:Organization
Organization Name:DELTA DRUGS II INC
Other - Org Name:DELTA DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:AVAKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-245-2325
Mailing Address - Street 1:13085 CENTRAL AVE
Mailing Address - Street 2:UNIT 7
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-4152
Mailing Address - Country:US
Mailing Address - Phone:951-245-2325
Mailing Address - Fax:951-245-4295
Practice Address - Street 1:13085 CENTRAL AVE
Practice Address - Street 2:UNIT 7
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-4152
Practice Address - Country:US
Practice Address - Phone:951-245-2325
Practice Address - Fax:951-245-4295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY465433336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA465430Medicaid
0509678OtherNCPDP PROVIDER IDENTIFICATION NUMBER
CAPHA465430Medicaid