Provider Demographics
NPI:1194334375
Name:LADELFA, LUCIANO MICHAEL (PHARMD)
Entity type:Individual
Prefix:
First Name:LUCIANO
Middle Name:MICHAEL
Last Name:LADELFA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1357 E COURT ST
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-5130
Mailing Address - Country:US
Mailing Address - Phone:830-372-3360
Mailing Address - Fax:
Practice Address - Street 1:2901 E BROAD ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-9147
Practice Address - Country:US
Practice Address - Phone:682-518-7219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64267183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist