Provider Demographics
NPI:1417454703
Name:SHRI LAKE SHORE PHARMACY
Entity Type:Organization
Organization Name:SHRI LAKE SHORE PHARMACY
Other - Org Name:LAKE SHORE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:862-701-5808
Mailing Address - Street 1:299 PARSIPPANY RD
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-5176
Mailing Address - Country:US
Mailing Address - Phone:862-701-5808
Mailing Address - Fax:862-701-5809
Practice Address - Street 1:299 PARSIPPANY RD
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-5176
Practice Address - Country:US
Practice Address - Phone:862-701-5808
Practice Address - Fax:862-701-5809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-12
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS007615003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2176787OtherPK