MEDICARE: LACROSS DRUGS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	032038	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2141681	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447696893
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LACROSS DRUGS INC

Provider Business Mailing Address
First Line	:	530 E 138TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10454-4906
Country	:	US
Telephone Number	:	718-665-5474
Fax Number	:	718-665-2005

Provider Business Practice Location Address
First Line	:	530 E 138TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10454-4906
Country	:	US
Telephone Number	:	718-665-5474
Fax Number	:	718-665-2005

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SRILAKSHMI VEERAMACHANENI
Credential	:
Telephone Number	:	718-665-5474

Provider Enumeration Date	:	05/13/2013
Last Update Date	:	02/16/2017

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Directions to “LACROSS DRUGS INC ” Practice Location

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