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Organization
LACONIA AVENUE PHARMACY CORP
Active
Organization
LACONIA AVENUE PHARMACY CORP
Active
Other names
Laconia Avenue Pharmacy Corp
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL ANOKYE (SUPERVISING PHARMACIST)
(917) 332-8533
Entity
Organization
Contact information
Practice address
4041 LACONIA AVE, BRONX, NY 10466-4917
(347) 843-7747
(347) 843-7748
Mailing address
4041 LACONIA AVE, BRONX, NY 10466-4917
(347) 843-7747
(347) 843-7748
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
—
NULL
3336C0003X
Community/Retail Pharmacy
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2168990
PK
—
Enumeration date
04/19/2017
Last updated
05/04/2017
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