Organization
L PARK LLC
Active
Other names
Gilmore Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
ILEANA DOMINGUEZ RPHD (PRESIDENT/PIC)
(201) 868-5005
Entity
Organization
Contact information
Practice address
6000 PARK AVE, WEST NEW YORK, NJ 07093
(201) 868-5005
(201) 868-5974
Mailing address
6000 PARK AVE, WEST NEW YORK, NJ 07093
(201) 868-5005
(201) 868-5974
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
3201
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0547361
—
NJ
01
—
3123786
NCPDP
—
Enumeration date
04/06/2007
Last updated
10/01/2018
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