Provider Demographics
NPI:1306180997
Name:LORDONI DISCOUNT PHARMACY INC
Entity Type:Organization
Organization Name:LORDONI DISCOUNT PHARMACY INC
Other - Org Name:LORDONI DISCOUNT PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLU
Authorized Official - Middle Name:
Authorized Official - Last Name:ONI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-415-9534
Mailing Address - Street 1:6300 N WICKHAM RD
Mailing Address - Street 2:SUITE 126
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-2028
Mailing Address - Country:US
Mailing Address - Phone:321-610-3114
Mailing Address - Fax:321-622-8609
Practice Address - Street 1:6300 N WICKHAM RD
Practice Address - Street 2:SUITE 126
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-2028
Practice Address - Country:US
Practice Address - Phone:321-610-3114
Practice Address - Fax:321-622-8609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-20
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336L0003X
FLPH264713336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008026601Medicaid
5712535OtherNCPDP PROVIDER IDENTIFICATION NUMBER
FL008026600Medicaid