Provider Demographics
NPI:1629004353
Name:LEMED PHARMACY III LLC
Entity Type:Organization
Organization Name:LEMED PHARMACY III LLC
Other - Org Name:LEMED PHARMACY III LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHALEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-913-4656
Mailing Address - Street 1:2417 3RD AVE STE 406
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-6340
Mailing Address - Country:US
Mailing Address - Phone:347-913-4656
Mailing Address - Fax:718-231-2727
Practice Address - Street 1:2417 3RD AVE STE 406
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-6340
Practice Address - Country:US
Practice Address - Phone:347-913-4656
Practice Address - Fax:718-231-2727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RO00160000333600000X
NY0268633336C0003X
PANP0009573336C0003X
CTPCN.00033173336C0003X
3336C0003X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0409884Medicaid
WI100136100Medicaid
IN300039510Medicaid
MNAPPROVEDMedicaid
NY02581813Medicaid
VT6705116Medicaid
CO9000185827Medicaid
PA103767935-0001Medicaid
NV250010607Medicaid
MD651077900Medicaid