Provider Demographics
NPI:1609910017
Name:LB PHARMACY INC
Entity Type:Organization
Organization Name:LB PHARMACY INC
Other - Org Name:KAY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PRAKASH
Authorized Official - Middle Name:
Authorized Official - Last Name:MADDALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-441-8470
Mailing Address - Street 1:448 CHAMBERLAIN AVE
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07522-1009
Mailing Address - Country:US
Mailing Address - Phone:973-942-8296
Mailing Address - Fax:973-942-1213
Practice Address - Street 1:448 CHAMBERLAIN AVE
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07522-1009
Practice Address - Country:US
Practice Address - Phone:973-942-8296
Practice Address - Fax:973-942-1213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-18
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NJ28RS004214003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2137389OtherPK
NJ0355682Medicaid
3100257OtherNCPDP PROVIDER IDENTIFICATION NUMBER