Healthcare Provider Details

I. General information

NPI: 1437545035
Provider Name (Legal Business Name): LG DRUGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2015
Last Update Date: 05/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 CHAUNCEY ST
BROOKLYN NY
11233-2154
US

IV. Provider business mailing address

PO BOX 330278
BROOKLYN NY
11233-0278
US

V. Phone/Fax

Practice location:
  • Phone: 718-484-7166
  • Fax:
Mailing address:
  • Phone: 718-484-7166
  • Fax:

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 TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number033495
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. NGOZI AGBASIONWE
Title or Position: SUPERVISING PHARMACIST
Credential:
Phone: 347-424-6845