Provider Demographics
NPI:1134179435
Name:DEBALKO'S PHARMACY INC
Entity type:Organization
Organization Name:DEBALKO'S PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:DEBALKO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, PHARMD
Authorized Official - Phone:570-929-2028
Mailing Address - Street 1:322 S HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:MCADOO
Mailing Address - State:PA
Mailing Address - Zip Code:18237-1608
Mailing Address - Country:US
Mailing Address - Phone:570-929-1130
Mailing Address - Fax:570-929-1208
Practice Address - Street 1:322 S HANCOCK ST
Practice Address - Street 2:
Practice Address - City:MCADOO
Practice Address - State:PA
Practice Address - Zip Code:18237-1608
Practice Address - Country:US
Practice Address - Phone:570-929-1130
Practice Address - Fax:570-929-1208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP412373L332BP3500X, 3336H0001X, 332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA39HI25OtherCAPITAL BLUE CROSS IV
PA39HA85OtherCAPITAL BLUE CROSS DME
PA996009OtherNEPA BC IV PROVIDER
PAPP412373LOtherPHARMACY LICENSE NUMBER
PA001017817Medicaid
PA075861OtherIST PRIORITY IV PROVIDER
PA237105OtherBLUE SHIELD IV
PABS0114619OtherDEA REGISTRATION