Provider Demographics
NPI:1760035687
Name:DELJIM INCORPORATED
Entity Type:Organization
Organization Name:DELJIM INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JIMI
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEMENTI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:817-715-0908
Mailing Address - Street 1:3215 WINDING RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-8837
Mailing Address - Country:US
Mailing Address - Phone:817-907-7391
Mailing Address - Fax:682-385-9102
Practice Address - Street 1:1136 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-3469
Practice Address - Country:US
Practice Address - Phone:817-715-0908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy