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General NPI Number Information
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NPI Number | 1588893002
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Entity Type | Organization
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Legal Business Name | LUBA PHARMACY INC.
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Dates
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Enumeration Date | 07/06/2009
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Last Update Date | 07/06/2009
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Provider Practice Location Address
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Address Line | 9914 63RD RD
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City | REGO PARK
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State | NY
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Zip | 11374-1940
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Country | US
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Telephone | 347-554-3629
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Fax |
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Provider Business Mailing Address
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Address Line | 9914 63RD RD
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City | REGO PARK
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State | NY
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Zip | 11374-1940
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Country | US
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Telephone | 347-554-3629
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. VYACHESLAV ISAKOV
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Credential | R.PH.
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Telephone | 347-554-3629
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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