Provider Demographics
NPI:1417361791
Name:LONG BEACH PHARMACY LLC.
Entity Type:Organization
Organization Name:LONG BEACH PHARMACY LLC.
Other - Org Name:HARRY'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SRIHARI
Authorized Official - Middle Name:
Authorized Official - Last Name:VUTUKURI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-889-8877
Mailing Address - Street 1:251 W PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-3222
Mailing Address - Country:US
Mailing Address - Phone:516-889-8877
Mailing Address - Fax:516-889-8876
Practice Address - Street 1:251 W PARK AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-3222
Practice Address - Country:US
Practice Address - Phone:516-889-8877
Practice Address - Fax:516-889-8876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-16
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0328433336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7243750001Medicare NSC