Provider Demographics
NPI:1205566155
Name:LDM PHARMACY INC
Entity type:Organization
Organization Name:LDM PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MENSAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-857-5889
Mailing Address - Street 1:2106 GRAND CONCOURSE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-2800
Mailing Address - Country:US
Mailing Address - Phone:718-367-4540
Mailing Address - Fax:
Practice Address - Street 1:2106 GRAND CONCOURSE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-2800
Practice Address - Country:US
Practice Address - Phone:718-367-4540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy