Provider Demographics
NPI:1902939416
Name:DELCO DRUGS AND SPECIALTY PHARMACY INC
Entity Type:Organization
Organization Name:DELCO DRUGS AND SPECIALTY PHARMACY INC
Other - Org Name:DELCO DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:ANNICHARICO
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARMACY
Authorized Official - Phone:718-984-6600
Mailing Address - Street 1:3833 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-3828
Mailing Address - Country:US
Mailing Address - Phone:718-984-6600
Mailing Address - Fax:718-984-6601
Practice Address - Street 1:3833 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-3828
Practice Address - Country:US
Practice Address - Phone:718-984-6600
Practice Address - Fax:718-984-6601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X, 3336S0011X
NY0289793336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2064371OtherPK
NY02985413Medicaid
NY6130030001Medicare NSC
NY00267450Medicaid
NYFD0982846OtherDEA