Provider Demographics
NPI:1538694955
Name:ALLURE SPECIALTY PHARMACY
Entity Type:Organization
Organization Name:ALLURE SPECIALTY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:LUDOVICK
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUMBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-293-1559
Mailing Address - Street 1:4377 BRONX BLVD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466
Mailing Address - Country:US
Mailing Address - Phone:866-293-1559
Mailing Address - Fax:888-828-6230
Practice Address - Street 1:4377 BRONX BLVD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466
Practice Address - Country:US
Practice Address - Phone:866-293-1559
Practice Address - Fax:888-828-6230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-23
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Multi-Specialty
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04949437Medicaid