MEDICARE: L.D.C. PHARMACY CORP

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	:	1942847371
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	L.D.C. PHARMACY CORP

Provider Business Mailing Address
First Line	:	1825 MADISON AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10035-3829
Country	:	US
Telephone Number	:	212-369-5555
Fax Number	:	212-534-4517

Provider Business Practice Location Address
First Line	:	1825 MADISON AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10035-3829
Country	:	US
Telephone Number	:	212-369-5555
Fax Number	:	212-534-4517

Authorized Official
Title or Position	:	CFO
Name	:	MRS. MARILDA BONILLA-DITTA
Credential	:
Telephone Number	:	212-369-5555

Provider Enumeration Date	:	12/04/2019
Last Update Date	:	02/14/2022

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