MEDICARE: LEXINGTON SPECIALTY PHARMACY, 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
2	3336S0011X	Specialty Pharmacy

General Provider Information

NPI Number	:	1760223382
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEXINGTON SPECIALTY PHARMACY, INC.

Provider Business Mailing Address
First Line	:	1570 LEXINGTON AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10029-6205
Country	:	US
Telephone Number	:	212-722-5222
Fax Number	:	212-722-5226

Provider Business Practice Location Address
First Line	:	1570 LEXINGTON AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10029-6205
Country	:	US
Telephone Number	:	212-722-5222
Fax Number	:	212-722-5226

Authorized Official
Title or Position	:	SP
Name	:	A.D. WALLACE
Credential	:	PHARMD
Telephone Number	:	212-722-5222

Provider Enumeration Date	:	06/06/2024
Last Update Date	:	06/06/2024

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