MEDICARE: IKA3 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	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1609605310
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IKA3 LLC

Provider Business Mailing Address
First Line	:	2532 OAKLAND BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76103-3235
Country	:	US
Telephone Number	:	817-945-5405
Fax Number	:	817-945-5554

Provider Business Practice Location Address
First Line	:	2532 OAKLAND BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76103-3235
Country	:	US
Telephone Number	:	817-945-5405
Fax Number	:	817-945-5554

Authorized Official
Title or Position	:	MANAGER
Name	:	MOHIT KESHUBHAI DHOLARIA
Credential	:	PHARMD
Telephone Number	:	817-945-5405

Provider Enumeration Date	:	07/31/2024
Last Update Date	:	07/31/2024

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Directions to “IKA3 LLC ” Practice Location

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