Healthcare Provider Details

I. General information

NPI: 1013344001
Provider Name (Legal Business Name): LAGUARDIA PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2013
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10122 ASTORIA BLVD
EAST ELMHURST NY
11369-2059
US

IV. Provider business mailing address

10122 ASTORIA BLVD
EAST ELMHURST NY
11369-2059
US

V. Phone/Fax

Practice location:
  • Phone: 718-478-2576
  • Fax: 718-478-2142
Mailing address:
  • Phone: 718-478-2576
  • Fax: 718-478-2142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number032234
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SHAHNAWAZ KHAN
Title or Position: SUPERVISOR
Credential:
Phone: 718-478-2576