Provider Demographics
NPI:1679328116
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:
Authorized Official - First Name:JATIN
Authorized Official - Middle Name:KIRTIKUMAR
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:925-499-6368
Mailing Address - Street 1:1888 A ST
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-2602
Mailing Address - Country:US
Mailing Address - Phone:925-499-6368
Mailing Address - Fax:925-238-0127
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:925-499-6368
Practice Address - Fax:925-238-0127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy