Healthcare Provider Details

I. General information

NPI: 1295012466
Provider Name (Legal Business Name): LILDARLIN INVESTMENTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2011
Last Update Date: 09/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1542 LAKEVIEW DR STE 1
SEBRING FL
33870-7957
US

IV. Provider business mailing address

4640 NADENA DR
SEBRING FL
33872-1779
US

V. Phone/Fax

Practice location:
  • Phone: 863-385-2200
  • Fax: 863-385-2225
Mailing address:
  • Phone: 863-458-2222
  • Fax: 863-658-2730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH25646
License Number StateFL

VIII. Authorized Official

Name: EMMANUEL WIAFE
Title or Position: PRESIDENT
Credential:
Phone: 863-458-2222