Provider Demographics
NPI:1013022045
Name:LVH INC
Entity Type:Organization
Organization Name:LVH INC
Other - Org Name:MEDICAP PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN HEUKELOM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:515-274-4609
Mailing Address - Street 1:5802 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50322-6132
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5802 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50322-6132
Practice Address - Country:US
Practice Address - Phone:515-274-4609
Practice Address - Fax:515-279-4960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA91333600000X
3336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0037556Medicaid
1601067OtherOTHER ID NUMBER-COMMERCIAL NUMBER
IAAM2227610OtherDEA #
IAIB1220Medicare PIN
IA0037556Medicaid