Organization
LIVONIA PHARMACY INC
Active
Other names
LIVONIA PHARMACY INC
Organization subpart
No
Provider details
NPI number
Authorized official
IMRAN SIDDIQUI (PRESIDENT,OWNER,AO)
(718) 484-8100
Entity
Organization
Contact information
Practice address
625A LIVONIA AVE, BROOKLYN, NY 11207-5301
(718) 484-8100
(718) 484-8103
Mailing address
625A LIVONIA AVE, BROOKLYN, NY 11207
(718) 484-8100
(718) 484-8103
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
033614
NY
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2152912
PK
—
Enumeration date
06/19/2015
Last updated
03/10/2017
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