Provider Demographics
NPI:1508324476
Name:L. A. PHARMACY FITNESS LLC
Entity Type:Organization
Organization Name:L. A. PHARMACY FITNESS LLC
Other - Org Name:LA FARMACIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:NIYAZOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-962-4444
Mailing Address - Street 1:709 E TREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-5001
Mailing Address - Country:US
Mailing Address - Phone:917-962-4444
Mailing Address - Fax:917-962-4451
Practice Address - Street 1:709 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-5001
Practice Address - Country:US
Practice Address - Phone:917-962-4444
Practice Address - Fax:917-962-4451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy