Provider Demographics
NPI:1417664822
Name:LEC PHARMA, LLC
Entity Type:Organization
Organization Name:LEC PHARMA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EZRA
Authorized Official - Middle Name:F
Authorized Official - Last Name:GRUSZYNSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-854-7425
Mailing Address - Street 1:1378 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143
Mailing Address - Country:US
Mailing Address - Phone:715-732-0717
Mailing Address - Fax:715-732-0596
Practice Address - Street 1:1378 MAIN ST
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-2425
Practice Address - Country:US
Practice Address - Phone:715-732-0717
Practice Address - Fax:715-732-0596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy