Provider Demographics
NPI:1427688316
Name:DELTA MEDICAL PHARMACY ANTIOCH
Entity type:Organization
Organization Name:DELTA MEDICAL PHARMACY ANTIOCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JATIN
Authorized Official - Middle Name:KIRTIKUMAR
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-695-6987
Mailing Address - Street 1:1307 CARLISLE CT
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-1761
Mailing Address - Country:US
Mailing Address - Phone:925-695-6987
Mailing Address - Fax:
Practice Address - Street 1:1888 A ST
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-2602
Practice Address - Country:US
Practice Address - Phone:925-695-6987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-21
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy