Organization
LAKE SUCCESS RX CORP
Active
Other names
PHARMACONIC
Organization subpart
No
Provider details
NPI number
Authorized official
STANISLAV ZAVULUNOV (PRESIDENT)
(516) 502-4170
Entity
Organization
Contact information
Practice address
1566A UNION TPKE, NEW HYDE PARK, NY 11040-1762
(516) 502-4170
(516) 502-4168
Mailing address
1566A UNION TPKE, NEW HYDE PARK, NY 11040-1762
(516) 502-4170
(516) 502-4168
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
12/20/2021
Last updated
12/20/2021
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