Provider Demographics
NPI:1114915774
Name:BRITTANY PHARMACY CORP.
Entity Type:Organization
Organization Name:BRITTANY PHARMACY CORP.
Other - Org Name:L&A PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUBA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALYASNY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-339-3131
Mailing Address - Street 1:395 AVENUE X
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-6004
Mailing Address - Country:US
Mailing Address - Phone:718-339-3131
Mailing Address - Fax:718-339-9232
Practice Address - Street 1:395 AVENUE X
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-6004
Practice Address - Country:US
Practice Address - Phone:718-339-3131
Practice Address - Fax:718-339-9232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025310183500000X, 1835N1003X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No1835N1003XPharmacy Service ProvidersPharmacistNutrition SupportGroup - Single Specialty
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM025310OtherPHARMACY LICENSE NUMBER
NY3326231OtherNCPDP NUMBER
NM02269836Medicaid
NYJ4TOtherETIN NUMBER
NYJ4TOtherETIN NUMBER
NY4494860001Medicare NSC