Organization
YASHODA INC
Active
Other names
MOORES LAKE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
VENKATA MUDUNURI RPH (RPH IN CHARGE)
(302) 697-0200
Entity
Organization
Contact information
Practice address
18 W LEBANON RD, DOVER, DE 19901-6248
(302) 697-0200
(302) 697-8205
Mailing address
18 W LEBANON RD, DOVER, DE 19901-6248
(302) 697-0200
(302) 697-8205
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
A30000937
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0802327
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
1000038163
—
DE
Enumeration date
09/12/2006
Last updated
09/13/2012
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