Provider Demographics
NPI:1447354402
Name:INCA ENTERPRISES INC
Entity type:Organization
Organization Name:INCA ENTERPRISES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLOVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BURCH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:318-865-0234
Mailing Address - Street 1:PO BOX 6119
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71136-6119
Mailing Address - Country:US
Mailing Address - Phone:318-865-0234
Mailing Address - Fax:318-865-3972
Practice Address - Street 1:1847 LINE AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4611
Practice Address - Country:US
Practice Address - Phone:318-222-8477
Practice Address - Fax:318-222-8487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
LAPHY.003693-IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1266957Medicaid
2034911OtherPK
1216760001Medicare NSC