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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