Healthcare Provider Details

I. General information

NPI: 1629004353
Provider Name (Legal Business Name): LEMED PHARMACY III LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2417 3RD AVE STE 406
BRONX NY
10451-6340
US

IV. Provider business mailing address

2417 3RD AVE STE 406
BRONX NY
10451-6340
US

V. Phone/Fax

Practice location:
  • Phone: 347-913-4656
  • Fax: 718-231-2727
Mailing address:
  • Phone: 347-913-4656
  • Fax: 718-231-2727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number28RO00160000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number026863
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberNP000957
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPCN.0003317
License Number StateCT
# 5
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SHALEEN PATEL
Title or Position: CEO
Credential:
Phone: 347-913-4656