Healthcare Provider Details

I. General information

NPI: 1366989709
Provider Name (Legal Business Name): LDNR PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2017
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5620 WILBUR AVE SUITE 100
TARZANA CA
91356-1351
US

IV. Provider business mailing address

3033 W PRESIDENT GEORGE BUSH HWY STE 100
PLANO TX
75075-5752
US

V. Phone/Fax

Practice location:
  • Phone: 747-265-6781
  • Fax:
Mailing address:
  • Phone: 972-588-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number55415
License Number StateCA

VIII. Authorized Official

Name: ANTHONY MOLLICA
Title or Position: CEO
Credential:
Phone: 972-588-1000