Provider Demographics
NPI:1326205287
Name:LEVYS PHARMACY INC
Entity Type:Organization
Organization Name:LEVYS PHARMACY INC
Other - Org Name:LEVYS PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOSHE
Authorized Official - Middle Name:
Authorized Official - Last Name:BADALOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-633-4377
Mailing Address - Street 1:4021 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-3564
Mailing Address - Country:US
Mailing Address - Phone:718-633-4377
Mailing Address - Fax:718-633-4378
Practice Address - Street 1:4021 13TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-3564
Practice Address - Country:US
Practice Address - Phone:718-633-4377
Practice Address - Fax:718-633-4378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0289193336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02976447Medicaid
2070590OtherPK