Healthcare Provider Details

I. General information

NPI: 1972544302
Provider Name (Legal Business Name): LEVY'S PHARMACY OF LYNDHURST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 01/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 STUYVESANT AVE
LYNDHURST NJ
07071-1874
US

IV. Provider business mailing address

299 STUYVESANT AVE
LYNDHURST NJ
07071-1874
US

V. Phone/Fax

Practice location:
  • Phone: 201-438-1026
  • Fax: 201-438-1668
Mailing address:
  • Phone: 201-438-1026
  • Fax: 201-438-1668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number28RS00602800
License Number StateNJ

VIII. Authorized Official

Name: YOLANDA GARCIA
Title or Position: RPH IN CHARGE
Credential:
Phone: 201-438-1026