Provider Demographics
NPI:1023027653
Name:LADA PHARMACY
Entity Type:Organization
Organization Name:LADA PHARMACY
Other - Org Name:EMPIRE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LENA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-234-7272
Mailing Address - Street 1:1864 86TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-3107
Mailing Address - Country:US
Mailing Address - Phone:718-234-7272
Mailing Address - Fax:718-234-2360
Practice Address - Street 1:1864 86TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-3107
Practice Address - Country:US
Practice Address - Phone:718-234-7272
Practice Address - Fax:718-234-2360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0266403336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02570703Medicaid
NY5186270001Medicare NSC
NY02570703Medicaid