MEDICARE: LPJ RX 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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1730724691
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LPJ RX INC

Provider Business Mailing Address
First Line	:	209 E 165TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10456-6017
Country	:	US
Telephone Number	:	347-879-8007
Fax Number	:	347-879-8008

Provider Business Practice Location Address
First Line	:	209 E 165TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10456-6017
Country	:	US
Telephone Number	:	347-879-8007
Fax Number	:	347-879-8008

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JACQUELINE MOTA
Credential	:
Telephone Number	:	347-879-8007

Provider Enumeration Date	:	11/14/2019
Last Update Date	:	11/14/2019

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