MEDICARE: DLKA HOLDINGS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	PH-24338	FL

General Provider Information

NPI Number	:	1073815783
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DLKA HOLDINGS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 915726
Second Line	:
City	:	LONGWOOD
State	:	FL
Zip	:	32791-5726
Country	:	US
Telephone Number	:	407-682-3211
Fax Number	:	407-682-1314

Provider Business Practice Location Address
First Line	:	181 SABAL PALM DR STE 101
Second Line	:
City	:	LONGWOOD
State	:	FL
Zip	:	32779-2594
Country	:	US
Telephone Number	:	407-682-3211
Fax Number	:	407-682-1314

Authorized Official
Title or Position	:	MGRM
Name	:	ROBERT S MILLER
Credential	:	RPH, CPH
Telephone Number	:	407-682-3211

Provider Enumeration Date	:	12/01/2010
Last Update Date	:	12/01/2010

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