Provider Demographics
NPI:1972660926
Name:L.D.C. PHARMACY CORP.
Entity Type:Organization
Organization Name:L.D.C. PHARMACY CORP.
Other - Org Name:HEALTH CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:A
Authorized Official - Last Name:SKOPOV
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:212-369-5555
Mailing Address - Street 1:1825 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-3829
Mailing Address - Country:US
Mailing Address - Phone:212-369-5555
Mailing Address - Fax:212-348-7891
Practice Address - Street 1:1825 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035
Practice Address - Country:US
Practice Address - Phone:212-369-5555
Practice Address - Fax:212-534-4517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0163693336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3366766OtherNABP
NY00350289Medicaid
NY1258770002Medicare NSC