Healthcare Provider Details

I. General information

NPI: 1588988539
Provider Name (Legal Business Name): LEXINGTON AVENUE PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2010
Last Update Date: 03/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2056 LEXINGTON AVE
NEW YORK NY
10035-1732
US

IV. Provider business mailing address

2056 LEXINGTON AVE
NEW YORK NY
10035-1732
US

V. Phone/Fax

Practice location:
  • Phone: 212-426-5555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number030023
License Number StateNY

VIII. Authorized Official

Name: MR. HARDY CHUNG
Title or Position: VP
Credential:
Phone: 718-742-3400