Provider Demographics
NPI:1497839526
Name:LDCA ENTERPRISE INC
Entity Type:Organization
Organization Name:LDCA ENTERPRISE INC
Other - Org Name:CIV PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLAHERMOSA
Authorized Official - Suffix:
Authorized Official - Credentials:CPC, PMB
Authorized Official - Phone:787-374-7467
Mailing Address - Street 1:PO BOX 902
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-0902
Mailing Address - Country:US
Mailing Address - Phone:787-280-2288
Mailing Address - Fax:787-280-4569
Practice Address - Street 1:4 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-2289
Practice Address - Country:US
Practice Address - Phone:787-280-2288
Practice Address - Fax:787-280-4569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
PR16F24313336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
2087534OtherPK
5837810001Medicare NSC