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General NPI Number Information
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NPI Number | 1659431310
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Entity Type | Organization
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Legal Business Name | LOISAIDA RX INC
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 05/10/2013
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Provider Practice Location Address
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Address Line | 273 E 3RD ST
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City | NEW YORK
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State | NY
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Zip | 10009-7800
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Country | US
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Telephone | 212-254-7307
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Fax |
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Provider Business Mailing Address
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Address Line | 273 E 3RD ST
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City | NEW YORK
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State | NY
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Zip | 10009-7800
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Country | US
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Telephone | 212-254-7307
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Fax |
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Authorized Official
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Title or Position | SUPERVISING PHARMACIST
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Name | MR. JAGADEESH GUMMELLA
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Credential | R.PH
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Telephone | 212-254-7307
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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 | 025186
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License Number State | NY
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