Healthcare Provider Details

I. General information

NPI: 1578119749
Provider Name (Legal Business Name): 35 VALLEY AVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2019
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 VALLEY AVE
ELMSFORD NY
10523-3001
US

IV. Provider business mailing address

35 VALLEY AVE STE A
ELMSFORD NY
10523-3001
US

V. Phone/Fax

Practice location:
  • Phone: 914-840-5027
  • Fax: 914-840-5022
Mailing address:
  • Phone: 914-840-5027
  • Fax: 914-840-5022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOO SEONG LEE
Title or Position: PRESIDENT
Credential:
Phone: 914-924-9210