Provider Demographics
NPI:1174870695
Name:REHOBOTH PHARMACY INC
Entity type:Organization
Organization Name:REHOBOTH PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANANGER
Authorized Official - Prefix:
Authorized Official - First Name:NWAKAEGO
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUKWUNENYE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, PHARMD
Authorized Official - Phone:302-798-8900
Mailing Address - Street 1:2616 PHILADELPHIA PIKE STE B
Mailing Address - Street 2:UNIT B
Mailing Address - City:CLAYMONT
Mailing Address - State:DE
Mailing Address - Zip Code:19703-2520
Mailing Address - Country:US
Mailing Address - Phone:302-798-8900
Mailing Address - Fax:302-798-8100
Practice Address - Street 1:2616 PHILADELPHIA PIKE STE B
Practice Address - Street 2:UNIT B
Practice Address - City:CLAYMONT
Practice Address - State:DE
Practice Address - Zip Code:19703-2520
Practice Address - Country:US
Practice Address - Phone:302-798-8900
Practice Address - Fax:302-798-8100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-14
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
DEA3-0009523336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1174870695Medicaid
2136823OtherPK