Organization
LOISAIDA RX INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAGADEESH GUMMELLA R.PH (SUPERVISING PHARMACIST)
(212) 254-7307
Entity
Organization
Contact information
Practice address
273 E 3RD ST, NEW YORK, NY 10009-7800
(212) 254-7307
Mailing address
273 E 3RD ST, NEW YORK, NY 10009-7800
(212) 254-7307
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
025186
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02182185
—
NY
Enumeration date
12/11/2006
Last updated
05/10/2013
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