Organization
LAKE AVE PHARMA LLC
Active
Other names
LAKE AVE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELINE BISSAH (SUPERVISING PHARMACIST)
(914) 965-3034
Entity
Organization
Contact information
Practice address
130 LAKE AVE, YONKERS, NY 10703-2713
(914) 965-3034
(914) 965-4176
Mailing address
130 LAKE AVE, YONKERS, NY 10703-2713
(914) 965-3034
(914) 965-4176
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
08/13/2021
Last updated
02/25/2022
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