Provider Demographics
NPI:1134282486
Name:LORVEN PHARMACY LLC
Entity Type:Organization
Organization Name:LORVEN PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SRIKANTH
Authorized Official - Middle Name:
Authorized Official - Last Name:AITHARAJU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-349-2255
Mailing Address - Street 1:942 MANHATTAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222
Mailing Address - Country:US
Mailing Address - Phone:718-349-2255
Mailing Address - Fax:718-349-2260
Practice Address - Street 1:942 MANHATTAN AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222
Practice Address - Country:US
Practice Address - Phone:718-349-2255
Practice Address - Fax:718-349-2260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027285333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02664588Medicaid
NY5456860001Medicare NSC