Organization
DEBALKO'S PHARMACY INC
Active
Organization
DEBALKO'S PHARMACY INC
Active
Other names
DeBalko's Standard Drug
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN NICHOLAS DEBALKO RPH, PHARMD (PRESIDENT)
(570) 929-2028
Entity
Organization
Contact information
Practice address
322 S HANCOCK ST, MCADOO, PA 18237-1608
(570) 929-1130
(570) 929-1208
Mailing address
322 S HANCOCK ST, MCADOO, PA 18237-1608
(570) 929-1130
(570) 929-1208
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
PP412373L
PA
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
PP412373L
PA
3336C0003X
Community/Retail Pharmacy
Primary
PP412373L
PA
3336H0001X
Home Infusion Therapy Pharmacy
PP412373L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001017817
—
PA
01
—
075861
IST PRIORITY IV PROVIDER
PA
01
—
237105
BLUE SHIELD IV
PA
01
—
39HA85
CAPITAL BLUE CROSS DME
PA
01
—
39HI25
CAPITAL BLUE CROSS IV
PA
01
—
996009
NEPA BC IV PROVIDER
PA
01
—
PP412373L
PHARMACY LICENSE NUMBER
PA
Enumeration date
05/10/2006
Last updated
03/07/2023
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