Organization
CROWN PHARMA INC
Active
Other names
LAVIDA PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SHIVAKUMAR PINNOJU RPH (PHARMACY MANAGER / PHARMACIST)
(718) 426-2525
Entity
Organization
Contact information
Practice address
4020 82ND ST, ELMHURST, NY 11373-1305
(718) 426-2525
(718) 426-2523
Mailing address
4020 82ND ST, ELMHURST, NY 11373-1305
(718) 426-2525
(718) 426-2523
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
034371
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1407146855
—
NY
01
—
2164047
PK
—
Enumeration date
02/15/2016
Last updated
10/06/2020
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