# LACONIA AVENUE PHARMACY CORP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Laconia Avenue Pharmacy Corp
- **Organization subpart:** No

## Provider details

- **NPI number:** 1881128569
- **Authorized official:** DANIEL ANOKYE (SUPERVISING PHARMACIST)
- **Authorized official phone:** (917) 332-8533

## Contact information

- **Practice address:** 4041 LACONIA AVE, BRONX, NY 10466-4917
- **Practice address phone:** (347) 843-7747
- **Practice address fax:** (347) 843-7748
- **Mailing address:** 4041 LACONIA AVE, BRONX, NY 10466-4917
- **Mailing address phone:** (347) 843-7747
- **Mailing address fax:** (347) 843-7748

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | Yes |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 04/19/2017
- **Last updated:** 05/04/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2168990 | PK | — |