Provider Demographics
NPI:1720692908
Name:GERIATRX
Entity Type:Organization
Organization Name:GERIATRX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DELON
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:CANTERBURY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:404-484-5092
Mailing Address - Street 1:6409 FAYETTEVILLE RD STE 120-218
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6297
Mailing Address - Country:US
Mailing Address - Phone:404-484-5092
Mailing Address - Fax:
Practice Address - Street 1:1655 SNOWMASS WAY
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-4514
Practice Address - Country:US
Practice Address - Phone:404-484-5092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy