Provider Demographics
NPI:1386074607
Name:DR IKES PHARMACARE LLC
Entity type:Organization
Organization Name:DR IKES PHARMACARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LEO
Authorized Official - Middle Name:
Authorized Official - Last Name:LAFRANCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-242-8969
Mailing Address - Street 1:15853 MONTE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-7671
Mailing Address - Country:US
Mailing Address - Phone:818-696-2606
Mailing Address - Fax:818-432-2488
Practice Address - Street 1:15853 MONTE ST STE 101
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-7671
Practice Address - Country:US
Practice Address - Phone:818-696-2606
Practice Address - Fax:818-432-2488
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPTIO RX LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-22
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA58005OtherCA BOARD OF PHARMACY
CA1386074607Medicaid
2143140OtherPK