Provider Demographics
NPI:1316935349
Name:PHARMACY MANAGEMENT CORPORATION
Entity type:Organization
Organization Name:PHARMACY MANAGEMENT CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY TECH
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:CPHT
Authorized Official - Phone:302-798-6641
Mailing Address - Street 1:111 DARLEY RD
Mailing Address - Street 2:P.O. BOX 589
Mailing Address - City:CLAYMONT
Mailing Address - State:DE
Mailing Address - Zip Code:19703-2723
Mailing Address - Country:US
Mailing Address - Phone:302-798-6641
Mailing Address - Fax:302-798-1824
Practice Address - Street 1:111 DARLEY RD
Practice Address - Street 2:
Practice Address - City:CLAYMONT
Practice Address - State:DE
Practice Address - Zip Code:19703-2723
Practice Address - Country:US
Practice Address - Phone:302-798-6641
Practice Address - Fax:302-798-1824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0800626OtherNCPDP
DE0800626OtherNCPDP