Provider Demographics
NPI:1629069976
Name:LGDK LLC
Entity Type:Organization
Organization Name:LGDK LLC
Other - Org Name:SUGAR HILL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER LLC
Authorized Official - Prefix:
Authorized Official - First Name:LEB
Authorized Official - Middle Name:
Authorized Official - Last Name:GERSHKOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-281-8300
Mailing Address - Street 1:752 SAINT NICHOLAS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-4002
Mailing Address - Country:US
Mailing Address - Phone:212-281-8300
Mailing Address - Fax:212-281-2500
Practice Address - Street 1:752 SAINT NICHOLAS AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-4002
Practice Address - Country:US
Practice Address - Phone:212-281-8300
Practice Address - Fax:212-281-2500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336S0011X
NY0273513336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2065660OtherPK
NY02703042Medicaid
5499130001Medicare NSC
NY3347401OtherNCPDP#