Provider Demographics
NPI:1467457366
Name:LEM4, LTD
Entity Type:Organization
Organization Name:LEM4, LTD
Other - Org Name:FISHERS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LEIBFREID
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:814-623-5512
Mailing Address - Street 1:6091 CORTLAND RD
Mailing Address - Street 2:
Mailing Address - City:ALUM BANK
Mailing Address - State:PA
Mailing Address - Zip Code:15521
Mailing Address - Country:US
Mailing Address - Phone:814-623-5512
Mailing Address - Fax:814-623-0606
Practice Address - Street 1:654 EAST PITT ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:PA
Practice Address - Zip Code:15522
Practice Address - Country:US
Practice Address - Phone:814-623-5512
Practice Address - Fax:814-623-0606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
PAPP410773L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2081008OtherPK
PA1016125940003Medicaid
2081008OtherPK