Provider Demographics
NPI:1407847635
Name:LERIN DRUG CO, INC
Entity Type:Organization
Organization Name:LERIN DRUG CO, INC
Other - Org Name:TOWN DRUG AND SURGICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:NAVARRA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:516-650-1870
Mailing Address - Street 1:501 W 113TH ST
Mailing Address - Street 2:
Mailing Address - City:NY
Mailing Address - State:NY
Mailing Address - Zip Code:10025
Mailing Address - Country:US
Mailing Address - Phone:212-749-2677
Mailing Address - Fax:212-662-3148
Practice Address - Street 1:501 W 113TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-8073
Practice Address - Country:US
Practice Address - Phone:212-678-0636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-05
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY17529333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00719044Medicaid
NY0442330001Medicare NSC