=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982648739
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LI EZRA APOTHECARY LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2006
-----------------------------------------------------
Last Update Date | 04/10/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 690 CENTRAL AVE
-----------------------------------------------------
City | CEDARHURST
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11516-2307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-569-7820
-----------------------------------------------------
Fax | 516-569-0832
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 690 CENTRAL AVE
-----------------------------------------------------
City | CEDARHURST
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11516-2307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-569-7820
-----------------------------------------------------
Fax | 516-569-0832
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRES /SUPERVISING PHARM
-----------------------------------------------------
Name | SIDNEY LANGWEIL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 516-569-7820
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 019577
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------