Provider Demographics
NPI:1003950619
Name:RUSSELL AND LAWRIE APOTHECARY INC
Entity Type:Organization
Organization Name:RUSSELL AND LAWRIE APOTHECARY INC
Other - Org Name:TARRYTOWN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:YOUSEF
Authorized Official - Middle Name:
Authorized Official - Last Name:JAWAD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:914-631-0079
Mailing Address - Street 1:59 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-3208
Mailing Address - Country:US
Mailing Address - Phone:914-631-0079
Mailing Address - Fax:914-909-6385
Practice Address - Street 1:59 N BROADWAY
Practice Address - Street 2:
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-3208
Practice Address - Country:US
Practice Address - Phone:914-631-0079
Practice Address - Fax:914-909-6385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0279633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3352212OtherNCPDP PROVIDER IDENTIFICATION NUMBER