Provider Demographics
NPI:1982288601
Name:WILMINGTON VACCINES CORPORATION
Entity Type:Organization
Organization Name:WILMINGTON VACCINES CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:F
Authorized Official - Last Name:AMAKOBE
Authorized Official - Suffix:
Authorized Official - Credentials:DBA
Authorized Official - Phone:302-252-7279
Mailing Address - Street 1:915 N MADISON ST LOWR GROUND
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19801-1439
Mailing Address - Country:US
Mailing Address - Phone:302-803-5978
Mailing Address - Fax:
Practice Address - Street 1:915 N MADISON ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-1439
Practice Address - Country:US
Practice Address - Phone:302-803-5978
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-09
Last Update Date:2021-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
No261QM1000XAmbulatory Health Care FacilitiesClinic/CenterMigrant Health