Provider Demographics
NPI:1518745280
Name:LUXBURY VENTURES LLC
Entity Type:Organization
Organization Name:LUXBURY VENTURES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FADEKE
Authorized Official - Middle Name:H
Authorized Official - Last Name:SALAKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-663-5760
Mailing Address - Street 1:422 AUGUSTA DR E
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19608-2128
Mailing Address - Country:US
Mailing Address - Phone:484-794-7272
Mailing Address - Fax:610-378-9000
Practice Address - Street 1:440 LEHIGH ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19601-1750
Practice Address - Country:US
Practice Address - Phone:484-663-5760
Practice Address - Fax:610-378-9000
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LUXBURY VENTURES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-09-14
Last Update Date:2023-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1028072400001Medicaid