MEDICARE: VIDA CARE PHARMACY 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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1770129579
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIDA CARE PHARMACY LLC

Provider Business Mailing Address
First Line	:	3764 90TH ST
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-7830
Country	:	US
Telephone Number	:	718-779-2221
Fax Number	:	718-779-3600

Provider Business Practice Location Address
First Line	:	3764 90TH ST
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-7830
Country	:	US
Telephone Number	:	718-779-2221
Fax Number	:	718-779-3600

Authorized Official
Title or Position	:	MEMBER
Name	:	TING CHEN LEE
Credential	:
Telephone Number	:	718-899-0200

Provider Enumeration Date	:	11/27/2019
Last Update Date	:	09/04/2025

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