Healthcare Provider Details

I. General information

NPI: 1639349442
Provider Name (Legal Business Name): LEZRX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2008
Last Update Date: 06/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4737 ROUTE 209 LOT 2
ACCORD NY
12404-5754
US

IV. Provider business mailing address

PO BOX 505
ELLENVILLE NY
12428-0505
US

V. Phone/Fax

Practice location:
  • Phone: 845-626-1278
  • Fax: 845-626-1177
Mailing address:
  • Phone: 845-626-1278
  • Fax: 845-626-1177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number028821
License Number StateNY

VIII. Authorized Official

Name: LESLY DESARME
Title or Position: OWNER
Credential:
Phone: 845-626-1278