Provider Demographics
NPI:1548496425
Name:DELTONA PHARMACY OF FLORIDA LLC
Entity type:Organization
Organization Name:DELTONA PHARMACY OF FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAMKRISHNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-574-7600
Mailing Address - Street 1:776 DELTONA BLVD
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-7107
Mailing Address - Country:US
Mailing Address - Phone:386-574-7600
Mailing Address - Fax:386-574-1489
Practice Address - Street 1:776 DELTONA BLVD
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-7107
Practice Address - Country:US
Practice Address - Phone:386-574-7600
Practice Address - Fax:386-574-1489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-04
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPH24105OtherFLORIDA LICENSE