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General NPI Number Information
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NPI Number | 1013978865
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Entity Type | Organization
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Legal Business Name | LAVIDA PHARMACY INC.
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Dates
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Enumeration Date | 03/31/2006
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Last Update Date | 07/16/2013
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Provider Practice Location Address
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Address Line | 4034 82ND ST
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City | ELMHURST
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State | NY
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Zip | 11373-1305
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Country | US
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Telephone | 718-426-2525
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Fax | 718-426-2523
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Provider Business Mailing Address
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Address Line | 4034 82ND ST
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City | ELMHURST
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State | NY
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Zip | 11373-1305
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Country | US
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Telephone | 718-426-2525
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Fax | 718-426-2523
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Authorized Official
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Title or Position | SUPERVISING PHARMACIST
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Name | TING CHEN LEE
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Credential |
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Telephone | 718-426-2525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 026192
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License Number State | NY
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