MEDICARE: LBRX LLC

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	333600000X	Pharmacy

General Provider Information

NPI Number	:	1295400356
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LBRX LLC

Provider Business Mailing Address
First Line	:	76 W GILBERT ST
Second Line	:
City	:	TINTON FALLS
State	:	NJ
Zip	:	07701-4918
Country	:	US
Telephone Number	:	609-606-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	404 INDIANA AVE
Second Line	:
City	:	LONG BRANCH
State	:	NJ
Zip	:	07740-6122
Country	:	US
Telephone Number	:	908-458-8710
Fax Number	:

Authorized Official
Title or Position	:	PHARMACIST
Name	:	ANN MARIE TAKACS
Credential	:	RPH
Telephone Number	:	908-458-8710

Provider Enumeration Date	:	08/11/2021
Last Update Date	:	09/03/2021

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