Provider Demographics
NPI:1376851048
Name:LEHIGH VALLEY PHARMACY LLC
Entity Type:Organization
Organization Name:LEHIGH VALLEY PHARMACY LLC
Other - Org Name:LEHIGH VALLEY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BADWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-905-4038
Mailing Address - Street 1:3055 W TILGHMAN ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-4256
Mailing Address - Country:US
Mailing Address - Phone:610-770-1212
Mailing Address - Fax:610-770-1266
Practice Address - Street 1:3055 W TILGHMAN ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-4256
Practice Address - Country:US
Practice Address - Phone:610-770-1212
Practice Address - Fax:610-770-1266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-16
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP-4820773336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102562263 0001Medicaid
3994995OtherNCPDP PROVIDER IDENTIFICATION NUMBER