Organization
LAKE AVE PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN A LUPO R PH (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
333600000X
Pharmacy
Primary
20096
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01105040
—
NY
01
—
3393206
NABP
—
Enumeration date
08/12/2006
Last updated
08/22/2020
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