Healthcare Provider Details

I. General information

NPI: 1023177490
Provider Name (Legal Business Name): LEWISBORO PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 11/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 N SALEM RD
CROSS RIVER NY
10518-1104
US

IV. Provider business mailing address

PO BOX 696
CROSS RIVER NY
10518-0696
US

V. Phone/Fax

Practice location:
  • Phone: 914-763-3152
  • Fax: 914-763-6567
Mailing address:
  • Phone: 914-763-3152
  • Fax: 914-763-6567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number014021
License Number StateNY

VIII. Authorized Official

Name: STUART FELDMAN
Title or Position: VP PIC OWNER
Credential: RPH
Phone: 914-763-3152