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General NPI Number Information
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NPI Number | 1932111861
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Entity Type | Organization
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Legal Business Name | LAKE AVE PHARMACY INC
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Dates
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Enumeration Date | 08/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 130 LAKE AVE
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City | YONKERS
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State | NY
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Zip | 10703-2713
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Country | US
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Telephone | 914-965-3034
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Fax | 914-965-4176
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Provider Business Mailing Address
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Address Line | 130 LAKE AVE
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City | YONKERS
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State | NY
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Zip | 10703-2713
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Country | US
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Telephone | 914-965-3034
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Fax | 914-965-4176
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Authorized Official
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Title or Position | PHARMACIST
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Name | MR. JOHN A LUPO
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Credential | R PH
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Telephone | 914-965-3034
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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 | 20096
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License Number State | NY
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