Provider Demographics
NPI:1588950414
Name:DLKA HOLDINGS, LLC
Entity type:Organization
Organization Name:DLKA HOLDINGS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:XXXXXXXXXXXXXXXX
Authorized Official - Prefix:MR
Authorized Official - First Name:XXXXXXXXXXX
Authorized Official - Middle Name:
Authorized Official - Last Name:XXXXXXXX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-288-8836
Mailing Address - Street 1:1361 E OSCEOLA PKWY
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-1605
Mailing Address - Country:US
Mailing Address - Phone:407-288-8836
Mailing Address - Fax:407-846-0111
Practice Address - Street 1:1361 E OSCEOLA PKWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-1605
Practice Address - Country:US
Practice Address - Phone:407-288-8836
Practice Address - Fax:407-846-0111
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DLKA HOLDKINGS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-20
Last Update Date:2012-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH243383336S0011X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003929100Medicaid
FL5706556OtherNCPDP PROVIDER IDENTIFICATION NUMBER